Rapid atrial stimulation: Successful method of conversion of atrial flutter and atrial tachycardia

Abstract

Atrial flutter and atrial tachycardia frequently pose difficult therapeutic problems. The established methods of treatment use various antiarrhythmic drugs or precordial countershock, or both. More recently, rapid atrial stimulation has been advocated as an alternative mode of conversion of these tachycardias. Most reports have shown a satisfying rate of conversion. Our experience represents the second largest reported series of patients to undergo cardioversion by this method. In all but 3 of 32 patients who underwent the procedure, either the atrial tachyarrhythmia was converted to sinus rhythm or the flutter-tachycardia was terminated with resultant atrial fibrillation. In 23 patients sinus rhythm was eventually established after atrial stimulation. This technique is confirmed as a safe and reliable method of terminating atrial flutter and atrial tachycardia. Reasons for preferring this mode of cardioversion of atrial tachy-cardia-flutter over direct-current countershock are discussed. Particular consideration should be given to conversion by rapid atrial stimulation in patients with possible digitalis toxicity and in all patients who have atrial flutter, atrial tachycardia or junctional tachy-cardia after open heart surgery.