1/54. Neonatal atrial flutter following fetal exposure to vibroacoustic stimulation.The use of vibroacoustic stimulation (VAS) has become a common modality for testing fetal well being. A case of neonatal atrial flutter, following fetal exposure to VAS is presented. It should be emphasized that although VAS is a common and reliable test for evaluating fetal status, complications may occur.- - - - - - - - - - ranking = 1keywords = atrial flutter, flutter (Clic here for more details about this article) |
2/54. electrocardiography in the patient with the wolff-parkinson-white syndrome: diagnostic and initial therapeutic issues.The wolff-parkinson-white syndrome (WPW), estimated to occur in approximately 0.1% to 3% of the general population, is a form of ventricular preexcitation involving an accessory conduction pathway. The definition of WPW relies on the following electrocardiographic features: (1) a PR interval less than 0.12 seconds (2) with a slurring of the initial segment of the QRS complex, known as a delta wave, (3) a QRS complex widening with a total duration greater than 0.12 seconds, and (4) secondary repolarization changes reflected in ST segment-T wave changes that are generally directed opposite (discordant) to the major delta wave and QRS complex changes. The accessory pathway bypasses the atrioventricular (AV) node, creating a direct electrical connection between the atria and ventricles. The majority of patients with preexcitation syndromes remain asymptomatic throughout their lives. When symptoms do occur they are usually secondary to tachyarrhythmias; the importance of recognizing this syndrome is that these patients may be at risk to develop a variety of supraventricular tachyarrhythmias which cause disabling symptoms and, in the extreme, sudden cardiac death. The tachyarrhythmias encountered in the WPW patient include paroxysmal supraventricular tachycardia (both the narrow QRS and wide QRS complex varieties), atrial fibrillation, atrial flutter, and ventricular fibrillation. Diagnostic and urgent, initial therapeutic issues based on initial electrocardiographic information are presented via 5 illustrative cases.- - - - - - - - - - ranking = 0.2keywords = atrial flutter, flutter (Clic here for more details about this article) |
3/54. syncope in patients with atrial flutter during treatment with class Ic antiarrhythmic drugs.We describe 2 atrial flutter (AFL) patients with syncope during treatment with class Ic antiarrhythmic drugs. During the syncope, 1:1 atrioventricular (AV) conduction during AFL preceded a wide QRS tachycardia. The class Ic drugs, flecainide and pilsicainide, slowed the atrial rate, resulting in AFL with 1:1 AV conduction, and the width of the QRS complexes became wider during the tachycardia. syncope was abolished after successful radiofrequency catheter ablation of the AFL. These potential proarrhythmic effects of the class Ic drugs should be taken into account in AFL patients, and concomitant use of beta-blocking agents would be critical to prevent proarrhythmias.- - - - - - - - - - ranking = 1keywords = atrial flutter, flutter (Clic here for more details about this article) |
4/54. Pacemaker-mediated tachycardia: management by pacemaker interrogation/reprogramming in the ED.We report a case of a patient with symptomatic pacemaker-mediated tachycardia (PMT). PMT should be suspected when asynchronous pacing induced by magnet application causes temporary resolution of an unknown tachycardia in a patient with a pacemaker. The underlying mechanism of PMT is either reentrant tachycardia or atrial triggering. PMT is better discerned with an intracardiac electrocardiogram (ECG) obtained through pacemaker interrogation (PI) than the standard 12-lead ECG. In the case reported, the interrogator was used to demonstrate that the initiating dysrhythmia was atrial flutter. Next, the programmer was used to overdrive the atrium restoring normal sinus rhythm. After pacemaker reprogramming, the patient was discharged from the emergency department (ED) in improved condition. We believe this to be the first reported case of a patient with PMT diagnosed, treated, and discharged effectively after PI, overdrive pacing and reprogramming from the ED. The pacemaker interrogator/programmer is a rapid noninvasive device that has practical applications in the ED.- - - - - - - - - - ranking = 0.2keywords = atrial flutter, flutter (Clic here for more details about this article) |
5/54. Atrial tachycardia with recipient-to-donor atrioatrial conduction and isthmus-dependent donor atrial flutter in a patient after orthotopic heart transplantation. Successful treatment by radiofrequency catheter ablation.Atrial arrhythmias are common after orthotopic heart transplantation. We report an unusual case of a patient after heart transplantation with 2 types of atrial arrhythmias: one was a macro-reentrant, incisional, recipient-atrial tachycardia conducted to the donor atrium, and the other was a common-type, isthmus-dependent atrial flutter in the donor atrium. These 2 arrhythmias were successfully treated with selective radiofrequency catheter ablation.- - - - - - - - - - ranking = 1keywords = atrial flutter, flutter (Clic here for more details about this article) |
6/54. Antitachycardia pacing therapies and arrhythmia monitoring diagnostics for the treatment of atrial fibrillation.The case of a patient with frequent episodes of atrial fibrillation that organizes into atrial flutter following implantation of a dual chamber, rate adaptive pacemaker is reported. The atrial flutter was effectively pace-terminated following activation of the atrial antitachycardia pacing therapies in the pacemaker. This resulted in a decrease in atrial fibrillation burden over time. The present case also illustrates the value of diagnostic data retrieved from pacemakers for monitoring atrial fibrillation frequency over time and evaluating the efficacy of pacing and drug therapy.- - - - - - - - - - ranking = 0.4keywords = atrial flutter, flutter (Clic here for more details about this article) |
7/54. An atypical atrial flutter of focal origin: a study using a noncontact mapping system.We report a case of focal atrial tachycardia with appearance suggestive of atypical atrial flutter in a 57-year-old man. Based on ECG criteria, tachycardia was misclassified as atypical atrial flutter. The electrophysiological study using a noncontact mapping system revealed a focal activity within the left upper pulmonary vein ostium. This case highlights the limitations of standard electrocardiographic and electrophysiological classifications of regular atrial tachycardia. This report also shows the relevance of new mapping techniques in the successful mapping and ablation of these arrhythmias, even those arising within the left atrium.- - - - - - - - - - ranking = 1.2keywords = atrial flutter, flutter (Clic here for more details about this article) |
8/54. Enlarged effects of adenosine in a septic patient with multiple myeloma and atrial flutter.We report the history of a 60-year-old patient with a multiple myeloma and staphylococcus aureus associated sepsis to whom adenosine in a dose of 6 mg was administered, when a regular, narrow QRS complex tachycardia at a heart rate of 120 beats/minute started. adenosine led to a complete AV-block and revealed atrial flutter. atrial flutter waves persisted for about 15 seconds and were followed by atrial and ventricular asystole for about 20 seconds. Repeated nonsustained polymorphic ventricular tachycardias followed and after about 90 seconds sinus rhythm was restored.- - - - - - - - - - ranking = 1.0715188161271keywords = atrial flutter, flutter (Clic here for more details about this article) |
9/54. Atrial tachycardia ablation in a patient with double outlet right ventricle corrected by surgery.The development of surgical and percutaneous techniques for treatment or palliation of congenital heart disease has prolonged survival in these patients and has increased late complications, particularly arrhythmias. Such arrhythmias are more frequently refractory to medical therapy, requiring percutaneous ablation. We present the clinical case of a 14-year-old child with complex congenital heart disease (double outlet right ventricle) who underwent two corrective surgeries (Rastelli operation and subsequent replacement of the homograft in the conduit connecting the right ventricle to the pulmonary artery; ventricular septal defect closure and tricuspid valve repair). After the second surgery the patient presented with wide complex syncopal tachycardia, refractory to medical therapy. Electrophysiologic study (EPS) identified an isthmus-dependent atrial flutter that was successfully treated by radiofrequency (RF) ablation (a linear block was created along the cavo-tricuspid isthmus). Three months later a new episode of tachycardia occurred, but without syncope. The second EPS revealed an atrial tachycardia originating from the lateral wall of the right atrium, which was treated by ablation with focal application of RF energy. Four months after the last EPS the child remains free of arrhythmic symptoms, under no anti-arrhythmic therapy.- - - - - - - - - - ranking = 0.2keywords = atrial flutter, flutter (Clic here for more details about this article) |
10/54. Flutter and fibrillation-like phenomenon of His bundle observed in a patient with persistent atrial standstill.A diagnosis of persistent atrial standstill was made in a patient with syncopal attacks, based on: (1) the lack of P waves both in the routine 12-lead electrocardiogram (ECG) and in the right atrial cavity lead; (2) the absence of "a waves in the right atrial pressure curve; and (3) the failure of the atria to respond to electrical stimulation. Compared with previously reported cases of persistent atrial standstill with a slow, regular escape rhythm of supraventricular origin, the present case was characterized by alternate periods of bradycardia and tachycardia, the latter being suggested as AV junctional tachycardia with exit block. Furthermore, the His bundle electrogram (HBE) showed either regular, high frequency deflictions or irregular, deformed potentials, suggesting flutter and fibrillation-like phenomena in the His bundle.- - - - - - - - - - ranking = 0.071518816127127keywords = flutter (Clic here for more details about this article) |
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