
This ECG is from the same patient. It was recorded a few minute later during gentle carotid sinus massage and now there is variable AV block. Note that the flutter waves are much easier to identify when there is 3:1 and 4:1AV block than when there is 2:1 block. The use of carotid sinus massage to increase AV block is an important diagnostic and therapeutic maneuver in patients with rapid supraventricular tachycardias.