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What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

Dr. Smith's ECG Blog

. = My Comment by K EN G RAUER, MD ( 3/15 /2023 ): = I found today’s case highly instructive in highlighting a number of important aspects regarding the presentation and initial treatment of a patient who presents to the ED with new AFib. I focus my comment on a few additional aspects regarding new AFib.

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Cardiomatics guide: Analyzing arrhythmias made easy

Cardiomatics

In healthy individuals occurs during exercising or strong emotions. Sinus bradycardia – sinus rhythm below 60 bpm is a sinus bradycardia. AFIB/AFL – atrial fibrillation or atrial flutter episodes. Sinus tachycardia – sinus rhythm above 100 bpm is a sinus tachycardia. Usually does not exceed 160 bpm.

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Wide-complex tachycardia that didn’t follow the rules

Dr. Smith's ECG Blog

Exercise can convert atrial flutter from 2:1 conduction to 1:1, apparently due to a combination of accelarated AV conduction and slowed flutter conduction. Only AFib was induced during EP study. It isn't entirely clear why our patient developed 1:1 conduction with atrial flutter.