A case of Reverse-Typical Atrial Flutter ! Answer about ECG case challenge (dated:15th/july/14)

A 24 years girl reffered from Vascular surgery to ICCU due to Dilated Cardiomyopathy (EF=30%) , and recently B/L Femoral embolectomy and Rt.Leg Fasciotomy done and there is also H/O right sided hemiparesis due to thromboembolic stroke , BP 80/50.

According to researches results and references :

1- Atrial Flutter is a supraventricular arrhythmia with regular atrial rate of 300+_ 50 beats per minute  ( here is the same ) 

2- Atrial Fibrillation from atrial flutter beside of fine and coarse F waves , differ by regular ventricular rhythms . ( here is the same ) 

3- There was clear cause for that , there is DCMP with EF=30% . this plus atrial flutter lead to thromboembolic stroke ! Af Vs. AFL have the same thromboembolic risk . 

4- there is no bifascicular block because we can say bifascicular block with RBBB not LBBB. 

5- Typical is associated with negative (f) waves in II, III, AVF- while reversed typical is accompanied with Positive (f) waves ( here the same ) .Once should be noted leads II, III, and aVF is more powerful indicator of Typical Vs. Atypical than Lead V1, it is believed that even in the absence of V1 for confirming of typical or atypical , the inferior leads are mostly trusted .  

6- by palpation we could find fixed ventricular rate . and etc...

Therefore , we can say , this is a case of Reverse-Typical Atrial Flutter with 4:1 AV conduction ration , and LBBB with atrial rate of about 300 and ventricular rate of about 66 beats per minute .