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Case Reports
. 2023 Jul 18;17(1):319.
doi: 10.1186/s13256-023-03947-5.

Failure of diltiazem to prevent 1:1 conduction of atrial flutter: a case report

K D Tiver  1   2 , D K Martin  3 , J Quah  1   2 , A Lahiri  1 , A N Ganesan  4   5
Affiliations
Case Reports

Failure of diltiazem to prevent 1:1 conduction of atrial flutter: a case report

K D Tiver et al. J Med Case Rep. .

Abstract

Background: Atrial flutter with 1:1 conduction to the ventricles is a dangerous cardiac arrhythmia. Contemporary guidelines recommend atrioventricular nodal blocking agents should be co-administered with class 1C anti-arrhythmics, as prophylaxis against 1:1 flutter. No guidance is provided on the type or strength of atrioventricular nodal blockade required, and in practice, these agents are frequently prescribed at low dose, or even omitted, due to their side effect profile.

Case presentation: A 62 year old Caucasian man with a history of paroxysmal atrial fibrillation treated with flecainide, presented with atrial flutter with 1:1 conduction to the ventricles and was cardioverted. Diltiazem was added to prevent this complication and he again presented with atrial flutter with 1:1 conduction to the ventricles, despite prophylaxis with coadministration of diltiazem.

Conclusions: This case report demonstrates failure of diltiazem to prevent 1:1 flutter in a patient chronically treated with flecainide for paroxysmal atrial fibrillation.

Keywords: 1:1 conduction; Atrial flutter; Case report; Class 1c; Diltiazem; Flecainide.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
12 lead electrocardiogram at presentation, demonstrating atrial flutter with 1:1 atrioventricular conduction. Arrows in lead III mark the flutter waves, demonstrating negative flutter waves in this lead, consistent with typical cavotricuspid isthmus (CTI) flutter, a counterclockwise macro re-entrant circuit in the right atrium. Due to aberrant conduction, the axis of this electrocardiogram is “north-west” or “extreme axis deviation” and there is an atypical right bundle branch block appearance
Fig. 2
Fig. 2
12 lead electrocardiogram in sinus rhythm. Normal sinus P waves, normal PR interval, normal QRS duration, normal QRS axis, normal QT interval, no T wave changes
See this image and copyright information in PMC

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