There are five parts to this answer

Questions & Answers

1. Is this atrial fibrillation? No, it's atrial fibrillation's cousin: ATRIAL FLUTTER
2. How do you think the rhythm relates to the symptom of pre-syncope? Atrial flutter and atrial fibrillation can cause pre-syncope, but it is relatively uncommon. More commonly, the hypoperfusion symptom comes at the time of abrupt spontaneous termination of the arrhythmia.

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59 yr old man with HTN, CAD and bypass surgery 2 years earlier, complicated by post-operative atrial fibrillation. Presents now with palpitations and pre-syncope.

Vent. rate 73 bpm
PR interval * ms

QRS duration 98 ms
QT/QTc 358/394 ms

P-R-T axes -83 -36 -29