Unusual Presentation of Atrial Flutter With Slow Ventricular Response

Varun Dobariya,Mohamed S Suliman,Davinder Singh,Samson Teka,Ebubechukwu Ezeh

doi:10.7759/cureus.15801

Abstract

Atrial flutter is usually associated with tachycardia with a ventricular rate of 150 beats per minute. Less commonly, it may be associated with a slow ventricular response (SVR). This is typically seen in patients taking atrioventricular (AV) nodal blocking agents such as beta-blockers. In the absence of these drugs, atrial flutter with SVR may suggest intrinsic AV nodal disease, electrolyte disturbances, or atrial disease. We present a case of atrial flutter with SVR in a patient who was not receiving AV nodal blocking agents.

Highlights

Less common, atrial flutter occurs in many of the same situations as atrial fibrillation
Atrial flutter typically causes tachycardia. It may be associated with a normal heart rate (HR) or even bradycardia, as seen in our patient [2]
Subsequent post-procedure ended 06/13/2021 Published 06/21/2021Electrocardiography (ECG) showed sinus rhythm with first-degree block and right bundle branch block (RBBB) with ventricular rate improving to 60-70 beats per minute

Summary

Introduction

Atrial flutter occurs in many of the same situations as atrial fibrillation. Less commonly, it may be associated with a normal heart rate (HR) or even bradycardia, as seen in our patient [2]. The patient stated that he had not taken his metoprolol for five days prior to the presentation He reported chronic dyspnea, unchanged from his baseline. ECG revealed atrial flutter with variable block ranging from 2:1 to 6:1, with a ventricular rate of 47 beats per minute and a right bundle branch block (RBBB). Magnesium was replaced but the patient’s ECG remained unchanged Subsequent post-procedure ECG showed sinus rhythm with first-degree block and RBBB with ventricular rate improving to 60-70 beats per minute. The patient’s HR remained within the normal range post-procedure He was subsequently discharged home on his home medications except for metoprolol which was held. He was given an appointment to follow up with EP as an outpatient

Discussion

Conclusions

Disclosures