Atrial flutter with spontaneous 1:1 atrioventricular conduction in adults: an uncommon but frequently missed cause for syncope/presyncope

Pacing and Clinical Electrophysiology : PACE
Gioia TurittoNabil El-Sherif

Abstract

To compare patients with atrial flutter (AFl) and 1:1 atrioventricular conduction (AVC) with patients with AFl and higher AVC. The characteristics of 19 patients with AFl and 1:1 AVC (group A) were compared with those of 116 consecutive patients with AFl and 2:1 AVC or higher degree AV block (group B). Age, gender, and left ventricular function were similar in the two groups. In group A versus group B, more patients had no structural heart disease (42% vs 17%, P < 0.05) and syncope/presyncope (90% vs 12%, P < 0.05). The AFl cycle length (CL) in group A was longer than in group B (265 +/- 24 ms vs 241 +/- 26 ms, P < 0.01). The transition from AFl with 1:1 to 2:1 AVC or vice versa was associated with small but definite changes in AFl CL, which showed larger variations in response to sympathetic stimulation. In group A patients who were studied off drugs, the atrial-His interval was not different from group B, but maximal atrial pacing rate with 1:1 AVC was faster. In group A, five patients were misdiagnosed as ventricular tachyarrhythmias, and three with a defibrillator received inappropriate shocks. Four patients had ablation of AVC and six had ablation of AFl circuit. The main difference between groups A and B may be an inheren...Continue Reading

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Citations

Jan 21, 2014·The Journal of Emergency Medicine·Jessie G Nelson, Dennis W Zhu
Oct 15, 2013·Pacing and Clinical Electrophysiology : PACE·Béatrice Brembilla-PerrotPierre Kaminsky
Aug 31, 2010·The American Journal of Medicine·Sridhar Venkatachalam, Curtis Rimmerman
Nov 5, 2014·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Nabil El-Sherif, Gioia Turitto
Apr 30, 2013·International Journal of Cardiology·Béatrice Brembilla-PerrotChristian De Chillou
Nov 20, 2014·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·J M Ter Maaten, R G Tieleman
Jun 27, 2018·Omega·Jocelyn M DeGroot, Alex P Leith
May 2, 2018·The Journal of the American Osteopathic Association·Ryan Burkhart, Gregg Gerasimon

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