![]() 3 Second, a more common situation, it occurs when patients with AFl and 2:1 or higher degree AV block (AVB) receive drugs with local anesthetic with or without anticholinergic effect like quinidine, procainamide, disopyramide, and flecainide. One, it could develop, although rarely, in patients with accessory pathways. There are three clinical/electrophysiological situations in which AFl in adults could present with 1:1 AVC. In contrast to fetal 1 or neonatal, 2 atrial flutter (AFl) in the adult population most commonly presents with 2:1 or higher degree of atrioventricular conduction (AVC). One should be aware of the different presentations of AFl with 1:1 AVC to avoid misdiagnosis/mismanagement and to consider the diagnosis in patients with narrow or wide QRS tachycardia and rates above 220/min. The latter affects not only AVC but also the AFl CL. Four patients had ablation of AVC and six had ablation of AFl circuit.Ĭonclusions: The main difference between groups A and B may be an inherent capacity of the AV node for faster conduction, especially in response to increased sympathetic tone. In group A, five patients were misdiagnosed as ventricular tachyarrhythmias, and three with a defibrillator received inappropriate shocks. In group A patients who were studied off drugs, the atrial-His interval was not different from group B, but maximal atrial pacing rate with 1:1 AVC was faster. The transition from AFl with 1:1 to 2:1 AVC or vice versa was associated with small but definite changes in AFl CL, which showed larger variations in response to sympathetic stimulation. The AFl cycle length (CL) in group A was longer than in group B (265 ± 24 ms vs 241 ± 26 ms, P < 0.01). In group A versus group B, more patients had no structural heart disease (42% vs 17%, P < 0.05) and syncope/presyncope (90% vs 12%, P < 0.05). Results: Age, gender, and left ventricular function were similar in the two groups. Methods: The characteristics of 19 patients with AFl and 1:1 AVC (group A) were compared with those of 116 consecutive patients with AFl and 2:1 AVC or higher degree AV block (group B). Aims: To compare patients with atrial flutter (AFl) and 1:1 atrioventricular conduction (AVC) with patients with AFl and higher AVC.
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