Atrial Flutter with Spontaneous 1:1 Atrioventricular Conduction in Adults: An Uncommon but Frequently Missed Cause for Syncope/Presyncope

Turitto, Gioia; Akhrass, Philippe; Leonardi, Marino; Saponieri, Cesare; Sette, Antonella; El‐Sherif, Nabil

doi:10.1111/j.1540-8159.2009.02180.x

Cited by 22 publications

(12 citation statements)

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“…In addition, 8.2% of episodes of inappropriate shocks had cycle lengths of <250 ms. In previous studies, the mean ventricular cycle length during atrial flutter with 1:1 atrioventricular (AV) conduction was between 265 ms and 292 ms. 26) 27) Enhanced AV nodal conduction in this young population, together with a short, heightened sympathetic tone that leads to shortening of the atrial flutter cycle length might have contributed to the very short cycle length of the SVAs. In our patient population, two patients with BS had three VT episodes with a cycle length of 282.0±11.7 ms, which activated ICD shocks.…”

Section: Discussionmentioning

confidence: 97%

Tachyarrhythmia Cycle Length in Appropriate versus Inappropriate Defibrillator Shocks in Brugada Syndrome, Early Repolarization Syndrome, or Idiopathic Ventricular Fibrillation

et al. 2016

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Background and ObjectivesImplantable cardioverter–defibrillators (ICDs) are indicated in patients with Brugada syndrome (BS), early repolarization syndrome (ERS), or idiopathic ventricular fibrillation (IVF) who are at high risk for sudden cardiac death. The optimal ICD programming for reducing inappropriate shocks in these patients remains to be determined. We investigated the difference in the mean cycle length of tachyarrhythmias that activated either appropriate or inappropriate ICD shocks in these three patient groups to determine the optimal ventricular fibrillation (VF) zone for minimizing inappropriate ICD shocks.Subjects and MethodsWe selected 41 patients (35 men) (mean age±standard deviation=42.6±13.0 year) who received ICD shocks between April 1996 and April 2014 to treat BS (n=24), ERS (n=9), or IVF (n=8). Clinical and ICD interrogation data were retrospectively collected and analyzed for all events with ICD shocks.ResultsOf the 244 episodes, 180 (73.8%) shocks were appropriate and 64 (26.2%) were inappropriate. The mean cycle lengths of the tachyarrhythmias that activated appropriate and inappropriate shocks were 178.9±28.7 ms and 284.8±24.4 ms, respectively (p<0.001). The cutoff value with the highest sensitivity and specificity for discriminating between appropriate and inappropriate shocks was 235 ms (sensitivity, 98.4%; specificity, 95.6%). When we programmed a single VF zone of ≤270 ms, inappropriate ICD shocks were reduced by 70.5% and appropriate shocks were missed in 1.7% of these patients.ConclusionProgramming of a single VF zone of ≤270 ms in patients with BS, ERS, or IVF could reduce inappropriate ICD shocks, with a low risk of missing appropriate shocks.

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Section: Discussionmentioning

confidence: 97%

Tachyarrhythmia Cycle Length in Appropriate versus Inappropriate Defibrillator Shocks in Brugada Syndrome, Early Repolarization Syndrome, or Idiopathic Ventricular Fibrillation

et al. 2016

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“…[1] However, accessory pathways can have shorter refractory periods than the AV node, thereby circumventing the AV node's protective delaying properties and allowing for more rapid conduction to the ventricles. [1][2][3] While normal conduction through the AV node and His-Purkinje system results in synchronized ventricular depolarization and thus a narrow QRS complex, most accessory pathways insert directly into the ventricular myocardium and conduct in an aberrant fashion, causing the ventricles to contract out of sync and thereby producing a wide QRS complex. In addition to direct conduction from the atria to the ventricles, accessory pathways can also cause wide complex tachycardias by forming reentrant circuits.…”

Section: Discussionmentioning

confidence: 99%

A case of wide complex tachycardia in wolff-parkinson-white syndrome

Lowenthal

Pagan

et al. 2019

CRIM

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The manifestation of atrial flutter, particularly with 1:1 conduction, is rare in patients with ventricular preexcitation secondary to Wolff-Parkinson-White Syndrome (WPW). Very few cases have been reported in the literature. We present a 40-year old male with a history of untreated WPW who presented with severe chest pain and shortness of breath. He was found to have a rapid, regular, wide complex tachycardia. He underwent successful synchronized cardioversion, in which the patient converted tonormal sinus rhythm with classic WPW waveform characteristics, including a shortened PR interval and prolonged QRS complex with a slurred upstroke. Surprisingly, a subsequent electrophysiology study revealed atrial flutter, with bystander conduction of 1:1 atrial flutter being the most likely cause of the patient’s presenting symptoms, and a posteroseptal accessory pathway consistent with the diagnosis of WPW. While considerably rarer than ventricular tachycardia or AVRT, it is nevertheless important for clinicians to consider atrial flutter with 1:1 conduction as a potential diagnosis in patients with WPW presenting with wide complex tachycardia.

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“…AFL was reported as an early sign of the cardiac complications of type 1 MD in childhood . In patients without type 1 MD, the association of 1/1 AFL with sympathetic hyperactivity, such as exercise, was well documented, either in untreated patients or in patients receiving antiarrhythmic drugs. Exercise allowed all the atrial impulses to pass through the AV node to the ventricles with a 1/1 conduction.…”

Section: Discussionmentioning

confidence: 99%

“…Exercise allowed all the atrial impulses to pass through the AV node to the ventricles with a 1/1 conduction. Turitto et al recommended to be aware of the different presentations of 1/1 AFL to avoid misdiagnosis/mismanagement and to consider the diagnosis in patients with narrow or wide QRS tachycardia and rates above 220 beats/min.…”

Section: Discussionmentioning

confidence: 99%

Atrial Flutter or Fibrillation is the Most Frequent and Life‐Threatening Arrhythmia in Myotonic Dystrophy

Brembilla‐Perrot¹,

Schwartz²,

Huttin³

et al. 2013

Pacing Clinical Electrophis

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Atrial Flutter with Spontaneous 1:1 Atrioventricular Conduction in Adults: An Uncommon but Frequently Missed Cause for Syncope/Presyncope

Abstract: Aims:To compare patients with atrial flutter (AFl) 220/min. (PACE 2009; 32:82-90) atrial flutter, AV conduction, ICD; syncope, tachycardia

Cited by 22 publications

References 15 publications

Tachyarrhythmia Cycle Length in Appropriate versus Inappropriate Defibrillator Shocks in Brugada Syndrome, Early Repolarization Syndrome, or Idiopathic Ventricular Fibrillation

Tachyarrhythmia Cycle Length in Appropriate versus Inappropriate Defibrillator Shocks in Brugada Syndrome, Early Repolarization Syndrome, or Idiopathic Ventricular Fibrillation

A case of wide complex tachycardia in wolff-parkinson-white syndrome

Atrial Flutter or Fibrillation is the Most Frequent and Life‐Threatening Arrhythmia in Myotonic Dystrophy

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