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Case Reports
. 2015 Jul 17;1(5):369-372.
doi: 10.1016/j.hrcr.2015.06.015. eCollection 2015 Sep.

Unusual mechanism of complete atrioventricular block following atrial flutter ablation

Frederic Georger  1 , Luc De Roy  2 , Camelia Sorea  1 , Jean-Paul Albenque  3 , Serge Boveda  3 , Bernard Belhassen  4
Affiliations
Case Reports

Unusual mechanism of complete atrioventricular block following atrial flutter ablation

Frederic Georger et al. HeartRhythm Case Rep. .
No abstract available

Keywords: AFL, atrial flutter; AV, atrioventricular; AVB, atrioventricular block; Atrial flutter; Atrioventricular block; CTI, cavotricuspid isthmus; Cavotricuspid isthmus; ECG, electrocardiogram; Pause-dependent atrioventricular block; Radiofrequency ablation; Tachycardia-dependent atrioventricular block.

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Figures

Figure 1
Figure 1
The left part of the electrocardiogram tracing shows typical flutter waves in leads II, III, and aVF conducted in a 2:1 fashion to the ventricles. After interruption of the flutter, a complete atrioventricular block occurs. Following a short pause, the acceleration of sinus rhythm rules out a potential vagal mechanism.
Figure 2
Figure 2
The top electrocardiogram tracings represent ECG, RVA represents a bipolar recording from the right ventricle and HBE recording from another bipolar catheter located close to the His bundle. Coronary sinus pacing at 500 milliseconds was conducted to the ventricles with a 2:1 infranodal block. After the pacing was stopped, we observed a complete infranodal atrioventricular block up to ventricular pacing.
Figure 3
Figure 3
A: The left part of the tracing shows atrial pacing at 600 milliseconds (A1-A1) followed by a 400-millisecond coupled extra stimulus (A2) that blocks after a His deflection. Two sinus beats (A3, A4) that occurred after a short pause as well as 2 atrial-paced extra beats were then blocked in the same fashion (cycle length: 600 milliseconds) (A5, A6). Finally, ventricular conduction was restored after a spontaneous ventricular activity (VS) with a left bundle branch block pattern [probably an escape beat (slightly prolonged HV) originating in or near the right bundle branch] followed by paced ventricular complexes (VP). B: The same strip at a lower speed showing the whole sequence (continued tracing) with restoration of normal AV conduction. Other abbreviations as in Figure 2.
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References

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