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

Gioia Turitto1, Philippe Akhrass, Marino Leonardi

  • 1Cardiac Electrophysiology Services, New York Methodist Hospital, Brooklyn, New York 11215, USA. gturitto@aol.com

Pacing and Clinical Electrophysiology : PACE
|January 15, 2009
PubMed

Insights

Patients with atrial flutter and 1:1 atrioventricular conduction (AVC) exhibit faster AV node conduction, especially with sympathetic stimulation. Awareness of this presentation is crucial to avoid misdiagnosis and mismanagement of atrial flutter.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Arrhythmias

Background:

  • Atrial flutter (AFl) with 1:1 atrioventricular conduction (AVC) presents unique challenges in diagnosis and management.
  • Understanding the electrophysiological differences between AFl with varying AVC degrees is critical for clinical practice.

Purpose of the Study:

  • To compare the clinical and electrophysiological characteristics of patients with AFl and 1:1 AVC versus those with AFl and higher-degree AVC.
  • To identify factors contributing to the distinct presentations of AFl with 1:1 AVC.

Main Methods:

  • Retrospective comparison of 19 patients with AFl and 1:1 AVC (Group A) against 116 patients with AFl and 2:1 AVC or higher (Group B).
  • Analysis included patient demographics, structural heart disease, symptoms, AFl cycle length (CL), and electrophysiological intervals.

Main Results:

  • Group A had more patients without structural heart disease (42% vs 17%) and with syncope/presyncope (90% vs 12%).
  • AFl CL was longer in Group A (265 ms vs 241 ms).
  • Group A demonstrated faster maximal atrial pacing rates with 1:1 AVC and a higher propensity for misdiagnosis as ventricular tachyarrhythmias.

Conclusions:

  • The AV node's inherent capacity for faster conduction, particularly with sympathetic stimulation, distinguishes patients with AFl and 1:1 AVC.
  • This faster conduction impacts both AVC and AFl CL, necessitating clinical awareness to prevent misdiagnosis and inappropriate treatment.
  • Consider AFl with 1:1 AVC in patients presenting with narrow or wide QRS tachycardia exceeding 220 bpm.
Abstract

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