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Then, the current flows to an area known as the bundle of His, which divides into two branches (LBB and RBB) and is the only physiological pathway connecting the atria with the ventricles. AFIB/AFL – atrial fibrillation or atrialflutter episodes. The left bundle and right bundle terminate in the Purkinje fibers.
Atrialflutter with 2:1 conduction. The atrialflutter rate is approximately 200 bpm, with 2:1 AV conduction resulting in ventricular rate almost exactly 100 bpm. Further history revealed she had new onset atrialflutter soon after her aortic surgery, and was put on flecainide approximately 1 month ago.
The rhythm differential for narrow, regular, and tachycardic is sinus rhythm, SVT (encompassing AVNRT, AVRT, atrial tach, etc), and atrialflutter (another supraventricular rhythm which is usually considered separately from SVTs). Therefore this patient is either in some form of SVT or atrialflutter.
Atrial Tachycardia (70%) and Typical AtrialFlutter (65%) were the most common SVTs ablated. This study underscores the need for risk stratification in patients with Fontan physiology undergoing SVT ablation and informs future research directions for enhancing ablation outcomes.
Since the most common ventricular response to untreated AFlutter is with 2:1 AV conduction — this results in a ventricular rate HALF as fast as the flutter rate in the atria — and 300 ÷ 2 ~150/minute ( usual range ~130-170/minute ). I suspected some type of lead connection "technical misadventure".
The ECG was interpreted as showing atrialflutter with 2:1 conduction. The heart rate could be compatible with that of a 2:1 conducted atrialflutter. Also, lead I could give the initial impression of showing flutter waves. The patient’s own underlying atrial rhythm is revealed at a heart rate in the mid 50s.
A series of cardiac arrhythmias were seen during the course of her resuscitation — including the interesting arrhythmia shown in the long lead II of Figure-1. PEARL # 3: At this point — the most time-efficient step for solving today's rhythm will be to determine the nature of atrial activity.
Finally, much of this correlates well with The new Canadian Syncope Arrhythmia Risk Score , just published in 2016, results of which are given below in the Annotated Bibliography. The most recent and probably best study is this: Canadian Syncope Arrhythmia Risk Score. Vasovagal syncope is generally benign. Thiruganasambandamoorthy, V.,
Conduction system pacing" is a newer technique that is being studied as a way of delivering more physiologic pacing, typically by inserting a lead into the area of the left bundle branch, or the bundle of His. But ectopic atrial tachycardia is most commonly an automatic arrhythmia.
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