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[1/1 nodo-ventricular conduction atrial flutter with amiodarone].

L Perdrix-Andujar1, O Paziaud, G Ricard

  • 1Services de Cardiologie, HEGP, rue Leblanc, Paris

Archives Des Maladies Du Coeur Et Des Vaisseaux
|April 9, 2005
PubMed
Summary

This study reports a rare case of 1/1 atrial flutter with amiodarone, highlighting its pro-arrhythmic effects and diagnostic challenges. Early diagnosis via esophageal recording is crucial for managing this poorly tolerated rhythm disturbance.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Pharmacology

Background:

  • 1/1 atrial flutter is a known complication of Class I anti-arrhythmics.
  • It is rarely associated with Class III anti-arrhythmics due to AV node refractoriness preventing 1/1 conduction.
  • Only seven cases of 1/1 atrial flutter with amiodarone have been previously reported.

Observation:

  • A new case of 1/1 atrial flutter occurred in a patient treated with amiodarone.
  • This case demonstrated amiodarone's pro-arrhythmic effects, including flutter cycle prolongation and infra-Hissian block.
  • The case also illustrated mechanisms of 1/1 conduction, such as prolonged flutter cycles and significant AV node permeability.

Findings:

  • The case highlights the pro-arrhythmic potential of amiodarone, leading to 1/1 atrial flutter.

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  • Diagnostic difficulties were encountered, emphasizing the need for advanced techniques like esophageal recording.
  • The rhythm disturbance was poorly tolerated, underscoring the importance of prompt diagnosis.

    • Implications:

    • This case expands the understanding of amiodarone's complex electrophysiological effects.
    • It stresses the importance of recognizing and diagnosing 1/1 atrial flutter, even with Class III agents.
    • Preventive strategies may involve amiodarone, digitalis, beta-blockers, or bradycardic calcium channel blockers.