1:1 atrial flutter induced by flecainide, whilst the patient was at rest

Comelli, Ivan; Pigna, Federica; Cervellin, Gianfranco

doi:10.1016/j.ajem.2018.07.040

Cited by 7 publications

(11 citation statements)

References 9 publications

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“…1:1 AFL induced by flecainide at rest has only been reported twice in the past 1 , 3 and to the best of our knowledge, it has never been reported with a rate of <200 b.p.m.…”

Section: Introductionmentioning

confidence: 92%

“…However, it is regarded rare and there is little awareness of this potentially lethal—should it degenerates into ventricular fibrillation complication. 2 , 3 Interestingly, in the majority of the reported cases, AFL with 1:1 conduction occurred during physical activity, possibly due to increased sympathetic tone. 3 In all those cases, the heart rate was >200 b.p.m.…”

Section: Introductionmentioning

confidence: 98%

“… 2 , 3 Interestingly, in the majority of the reported cases, AFL with 1:1 conduction occurred during physical activity, possibly due to increased sympathetic tone. 3 In all those cases, the heart rate was >200 b.p.m.…”

Section: Introductionmentioning

confidence: 98%

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Atrial flutter with flecainide-induced 1:1 conduction at a rate <200 b.p.m. at rest: a case report

Dardas

Khan

2021

European Heart Journal - Case Reports

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Background Class IC antiarrhythmic drug flecainide is commonly used in the management of atrial arrhythmias and in particular atrial fibrillation (AF). Although previously reported as a potential complication, atrial flutter (AFL) with 1:1 atrioventricular conduction is rare, with only few cases reported so far, most of which related to physical activity. In all previous reported cases, 1:1 conduction resulted in ventricular rates of more than 200 b.p.m. Case Summary We report the case of a 60 year old woman, who presented to our local emergency department with palpitations related to acute onset AF. The patient developed symptomatic 1:1 AFL with a rate of 192 b.p.m., shortly after administration of intravenous flecainide, which spontaneously converted back to AF and subsequently to sinus rhythm, with further administration of amiodarone and beta blocker. Discussion The case raises awareness of this rare but potentially life threatening complication to those using flecainide for pharmacological cardioversion of AF. QRS complex widening can be seen in the context of very rapid ventricular rates, posing additional diagnostic challenge, especially with rates of less than 200 b.p.m. Prescribing an AV nodal blocking agent, such as a beta-blocker, together with flecainide reduces significantly the risk of 1:1 conduction and should always be considered.

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“…1:1 AFL induced by flecainide at rest has only been reported twice in the past 1 , 3 and to the best of our knowledge, it has never been reported with a rate of <200 b.p.m.…”

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Atrial flutter with flecainide-induced 1:1 conduction at a rate <200 b.p.m. at rest: a case report

Dardas

Khan

2021

European Heart Journal - Case Reports

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“…When flecainide or propafenone is started with either approach, it is important also to start a low dose of either a beta blocker or a CCB to prevent the development of atrial flutter with rapid 1:1 conduction, a rhythm that can produce heart rates above 200 beats/min. 28 Both medications are metabolized by CYP2D6 and thus have many important drug interactions (see Table 1). It is important for clinicians to be aware of these important interactions.…”

Section: Important Medication Considerations and Drug Interactionsmentioning

confidence: 99%

Antiarrhythmic Drugs for Atrial Fibrillation in the Outpatient Setting: Common Clinical Scenarios and Pearls for the Primary Care Clinician

Tseng

Kowlgi

DeSimone

2021

Mayo Clinic Proceedings

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The management of atrial fibrillation (AF) in the outpatient setting has become more complex with the utilization of antiarrhythmic drugs (AADs) and increasing complexity of comorbid conditions. The primary care clinician is critically involved in the pharmacologic management of AF, whether it be direct prescription of AADs or managing potential drug-drug interactions with other medications. In this review, we provide instructive, high-yield clinical scenarios and quick clinical references to increase familiarity and comfort with the use of AADs.

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“…The exact incidence of this phenomenon is unclear, as most reports are in the form of case reports or small case series. [20][21][22] Fortunately, this symptomatic conversion is rare and the adequate use of AV node-blocking agents should prevent its occurrence. 1,2,23 A hybrid approach to rhythm management in patients with atrial fibrillation that converts to typical atrial flutter on class Ic agents Some have suggested this "proarrhythmic" effect of AADs (ie, conversion of AF to AFL) to be less of an obstacle and more so an opportunity, hypothesizing that, when such patients converted from AF to typical AFL, the addition of CTI ablation would not only address the treatment of AFL but also enhance the suppression of AF.…”

Section: Role Of Class Ic Antiarrhythmics For the Restoration Of Sinumentioning

confidence: 99%

Revisiting an Underrecognized Strategy for Rhythm Management: Hybrid Therapy for Patients who Convert from Atrial Fibrillation to Flutter on Antiarrhythmic Drugs

Riad¹,

Waldo²

2019

J Innov Cardiac Rhythm Manage.

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Atrial fibrillation (AF) is often treated with antiarrhythmic drugs (AADs) or catheter ablation. In a unique subset of patients, AF can convert to atrial flutter (AFL) after the initiation of an AAD. It has previously been shown that, in this subset of patients, cavotricuspid isthmus (CTI) ablation followed by the continuation of the AAD regimen has an unusually high rate of successfully maintaining sinus rhythm. This is an underrecognized approach toward rhythm management in such patients. However, the reason(s) for such a high degree of efficacy with this hybrid therapeutic approach are unclear. We suggest that conversion from AF to AFL selects for a group of patients in whom AF is particularly responsive to the effects of the AAD. Since CTI ablation is essentially curative of AFL, the combination of both techniques results in a high efficacy of sinus rhythm maintenance. Further investigation is required to confirm these hypotheses.

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1:1 atrial flutter induced by flecainide, whilst the patient was at rest

Cited by 7 publications

References 9 publications

Atrial flutter with flecainide-induced 1:1 conduction at a rate <200 b.p.m. at rest: a case report

Atrial flutter with flecainide-induced 1:1 conduction at a rate <200 b.p.m. at rest: a case report

Antiarrhythmic Drugs for Atrial Fibrillation in the Outpatient Setting: Common Clinical Scenarios and Pearls for the Primary Care Clinician

Revisiting an Underrecognized Strategy for Rhythm Management: Hybrid Therapy for Patients who Convert from Atrial Fibrillation to Flutter on Antiarrhythmic Drugs

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1:1 atrial flutter induced by flecainide, whilst the patient was at rest

Cited by 7 publications

References 9 publications

Atrial flutter with flecainide-induced 1:1 conduction at a rate &lt;200 b.p.m. at rest: a case report

Atrial flutter with flecainide-induced 1:1 conduction at a rate &lt;200 b.p.m. at rest: a case report

Antiarrhythmic Drugs for Atrial Fibrillation in the Outpatient Setting: Common Clinical Scenarios and Pearls for the Primary Care Clinician

Revisiting an Underrecognized Strategy for Rhythm Management: Hybrid Therapy for Patients who Convert from Atrial Fibrillation to Flutter on Antiarrhythmic Drugs

Contact Info

Product

Resources

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Atrial flutter with flecainide-induced 1:1 conduction at a rate <200 b.p.m. at rest: a case report

Atrial flutter with flecainide-induced 1:1 conduction at a rate <200 b.p.m. at rest: a case report