Atrial flutter with exit block.

Abstract:

:The mechanism of atrial flutter is controversial. A 76-year-old woman with rheumatic heart disease was referred to our clinic with an unusual rhythm disturbance which initially appeared to be classic atrial flutter at a rate of 300 beats/min. Later tracings, however, demonstrated a rate exactly one-half that of the earlier ECGs, with an identical p-wave morphology and vector. This latter rhythm also behaved in a manner expected for a flutter mechanism in that both spontaneously and with carotid pressure high-degree atrioventricular block occurred without alteration of the underlying atrial mechanism. Finally, the two rates interchanged spontaneously over several days without any significant interval changes in medical therapy. These findings were initially explained as probable digoxin toxicity. The underlying mechanism, however, was more likely atrial flutter with exit block and in this patient may have represented another facet of her sick sinus syndrome. This unusual phenomenon is discussed in terms of previous reports and possible implications for the mechanism of atrial flutter.

journal_name

Circulation

journal_title

Circulation

authors

Homcy CJ,Lorell B,Yurchak PM

doi

10.1161/01.cir.60.3.711

subject

Has Abstract

pub_date

1979-09-01 00:00:00

pages

711-4

issue

3

eissn

0009-7322

issn

1524-4539

journal_volume

60

pub_type

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