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Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...

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Failed Pacemaker Detection of Flecainide-Induced Atrial Flutter With One-to-One Atrioventricular Conduction.

Paul J Wurtz¹, Joseph Pearman², Kelvin N V Bush²

¹Department of Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA.

JACC. Case Reports

|May 23, 2025

Summary

Flecainide can convert atrial fibrillation into atrial flutter with 1:1 conduction, posing a risk for dangerous heart rhythms. Pacemaker limitations may hinder detection of these potentially life-threatening arrhythmias.

Keywords:

arrhythmia atrial fibrillation atrial flutter flecainide pacemaker wide-complex tachycardia

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Area of Science:

Cardiology
Electrophysiology
Pharmacology

Background:

Antiarrhythmic drugs for atrial fibrillation (AF) have variable efficacy and proarrhythmic potential.
Managing AF requires careful consideration of drug side effects and patient response.

Observation:

A patient presented with wide-complex tachycardia after amiodarone administration.
Electrocardiogram showed flecainide-induced atrial flutter with 1:1 AV conduction.
Pacemaker interrogation revealed undersensing of ventricular rates at 230 beats/min.

Findings:

Flecainide therapy can organize AF into atrial flutter (AFL).
This organized AFL can predispose to 1:1 atrioventricular (AV) conduction.
Pacemaker devices may exhibit limitations in detecting rapid ventricular rates during such events.

Implications:

This case highlights a critical limitation in pacemaker detection capabilities for specific arrhythmias.
Clinicians must be aware of flecainide's potential to induce organized atrial flutter with 1:1 conduction.
Careful device selection and monitoring are crucial for patients on antiarrhythmic therapy.