Cardiology: typical atrial flutter: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: typical atrial flutter

Sample item

A 66-year-old man has a regular narrow-complex tachycardia at 150 per minute. Adenosine transiently slows the ventricular rate and reveals a saw-tooth baseline at about 300 per minute, best seen in the inferior leads. The rhythm recurs despite drugs. What is the preferred definitive treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Cavotricuspid isthmus catheter ablation

This is typical atrial flutter, a macro-reentry circuit around the tricuspid annulus that depends on the cavotricuspid isthmus. Ablation of that isthmus creates a line of block and cures most patients, with a success rate higher than for drugs.

Option by option

  • A. Cavotricuspid isthmus catheter ablation (correct)

    Correct. Ablating the cavotricuspid isthmus interrupts the reentry circuit of typical flutter.

  • B. Pulmonary vein isolation by catheter

    Pulmonary vein isolation targets atrial fibrillation triggers rather than the flutter circuit.

  • C. AV node ablation with a pacemaker

    AV node ablation is a last resort for uncontrolled rates and leaves the patient pacemaker dependent.

  • D. Surgical division of an accessory pathway

    An accessory pathway is not involved in this rhythm.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Cavotricuspid isthmus catheter ablation. This is typical atrial flutter, a macro-reentry circuit around the tricuspid annulus that depends on the cavotricuspid isthmus.

Why is "Pulmonary vein isolation by catheter" not the answer?

Pulmonary vein isolation targets atrial fibrillation triggers rather than the flutter circuit.

Why is "AV node ablation with a pacemaker" not the answer?

AV node ablation is a last resort for uncontrolled rates and leaves the patient pacemaker dependent.

Why is "Surgical division of an accessory pathway" not the answer?

An accessory pathway is not involved in this rhythm.

What concept does this question test?

It tests Cardiology: typical atrial flutter in General Medicine. Ablation of that isthmus creates a line of block and cures most patients, with a success rate higher than for drugs.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: typical atrial flutter?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.