Predictors of atrial flutter with 1:1 conduction in patients treated with class I antiarrhythmic drugs for atrial tachyarrhythmias
Introduction
Class I antiarrhythmic agents are the drugs most frequently prescribed to suppress recurrences of atrial arrhythmias. They are known to be effective for the treatment of these arrhythmias. However, with the increasing use of such agents, it has become apparent that they may also induce or exacerbate cardiac arrhythmias.
The predictors of ventricular proarrhythmia are actually known, and in particular, existing organic heart disease augments the risk [1], [2], [3], [4], [5]. The risk factors promoting atrial proarrhythmias are unknown; a young patient without cardiac heart disease can be at risk of this accident. However, the risk of atrial flutter with 1:1 conduction during treatment with class I antiarrhythmic drugs has been reported since 1956 [6] with quinidine and later, successively, with all class I antiarrhythmic drugs [7], [8], [9], [10], [11].
Therefore, the purpose of the study was to identify the possible risk factors of atrial proarrhythmic effects related to class I antiarrhythmic drug by the analysis of 24 atrial flutters with 1:1 conduction in patients treated with class I antiarrhythmic drug.
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Study population
Twenty-four patients, eighteen males and six females, aged 31–78 years (mean 62±11) presented with atrial flutter and 1:1 conduction: patients were admitted for a regular tachycardia at a rate between 180 and 220 beats/min, mimicking a ventricular tachycardia in twenty-two patients (Fig. 1). Two remaining patients had a rapid and fine QRS complex tachycardia.
The diagnosis of the tachycardia nature was established by recording of the atrial electrogram with 1:1 ventricular response either by
Methods
Alter restoration of sinus rhythm and interruption of all antiarrhythmic drugs for five half-lives, systematic noninvasive and invasive studies were prospectively collected
- 1.
History and clinical data
- 2.
Recording of the 12-lead surface ECG; the duration of PR interval was automatically measured; the value of PR interval in each lead was also manually measured
- 3.
Two-dimensional echocardiogram
- 4.
Electrophysiological study including the study of AV conduction and programmed atrial and ventricular stimulation:
Clinical and technical data of the study population
An underlying heart disease was present in nine patients (37.5%), but the left ventricular ejection fraction was preserved in all these patients (>50%); three patients had a minor mitral or aortic insufficiency; two patients had hypertension; three patients had a coronary heart disease, without myocardial infarction and had a normal left ventricular function; another patient had a hypertrophic cardiomyopathy.
Left atrial anteroposterior diameter varied from 25 to 60 mm (38±11).
The automatic
Discussion
In the present study, the age and the presence of an underlying heart disease did not predict the occurrence of atrial flutter with 1:1 conduction. One sign was found to be associated with the risk of atrial proarrhythmia: all patients but one had either a short PR interval on leads V5, V6 of their surface ECG without other signs of preexcitation or the recording of SAECG demonstrated that the apparently normal PR interval was related to an increased P wave duration. The short AV nodal
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