Atrial flutter secondary to hypokalemia

Area of Science:

• Cardiology
• Electrophysiology
• Internal Medicine

Background:

• Atrial flutter is a common supraventricular tachyarrhythmia.
• The underlying causes of atrial flutter are diverse, including structural heart disease and electrolyte imbalances.
• The role of hypokalemia in initiating atrial flutter requires further elucidation.

Observation:

• A patient presented with recurrent episodes of atrial flutter.
• Electrophysiologic studies were conducted during both hypokalemic and normokalemic states.
• Atrial flutter was consistently inducible during hypokalemia but not after potassium correction.

Findings:

• Significant hypokalemia was identified as the direct cause of atrial flutter in this patient.
• Rapid atrial pacing could reproducibly initiate and terminate atrial flutter during hypokalemia.
• The arrhythmia became non-inducible following correction of the hypokalemia.

Implications:

• Hypokalemia can act as an arrhythmogenic trigger for atrial flutter, even in the absence of overt heart disease.
• In individuals with pre-existing atrial conduction abnormalities, hypokalemia may promote re-entrant atrial flutter by causing non-uniform atrial refractoriness and premature atrial beats.
• This finding underscores the importance of monitoring and correcting electrolyte imbalances, particularly potassium, in patients presenting with unexplained atrial arrhythmias.