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      Aleteo auricular con conducción Auriculoventricular 1:1 Descripción de un caso Translated title: Atrial flutter with 1:1 Atrioventricular conduction. Case report


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          Resumen El aleteo auricular (AA) con conducción auriculoventricular 1:1 es una condición de presentación infrecuente en la práctica clínica, se da debido a diversos factores entre los cuales los más importantes son la presencia de vías accesorias concomitantes o uso de ciertos medicamentos antiarrítmicos, el AA con conducción 1 a 1 cuando se desarrolla constituye una emergencia médica ya que tiene una frecuencia cardiaca regular y presenta QRS ancho puede confundirse con una taquicardia ventricular. Cuando se presenta esta condición se produce frecuentemente inestabilidad hemodinámica del paciente, por lo que se debe hacer su diagnóstico y tratamiento a la brevedad posible. En el presente reporte presentamos el caso de un paciente previamente portador de marcapasos que desarrolla una taquicardia de QRS ancho regular, que se diagnostica finalmente como AA con conducción 1 a 1, tratado con fármacos antiarrítmicos en primera instancia, logrando disminuir la frecuencia cardiaca y posteriormente la reversión del mismo.

          Translated abstract

          Abstract The atrial flutter(AF) with 1 to 1 atrio-ventricular (AV) conduction it's a rare medical condition secondary to several factors among which the most important are the association whit AV accessory pathways, or secondary to the use of some antiarrhythmic drugs. The AF with 1 to 1 AV conduction is a medical emergency and since it has a regular heart rate and presents wide QRS complex it can be confused with a ventricular tachycardia. When this condition occurs, it leads to hemodynamic instability of the patient, and that is why the diagnosis and treatment of this entity should be made as soon as possible. In the present report we present the case of a patient whit a previous pacemaker implantation who develops a regular wide QRS tachycardia, which is diagnosed as AF with 1 to 1 conduction and treated with antiarrhythmic drugs, first achieving a reduction in the heart rate and subsequently reaching its reversion

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          A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex.

          In the differential diagnosis of a tachycardia with a wide QRS complex (greater than or equal to 0.12 second) diagnostic mistakes are frequent. Therefore, we investigated the reasons for failure of presently available criteria, and we identified new, simpler criteria and incorporated them in a stepwise approach that provides better sensitivity and specificity for making a correct diagnosis. A prospective analysis revealed that current criteria had a poor specificity for the differential diagnosis. The value of four new criteria incorporated in a stepwise approach was prospectively analyzed in a total of 554 tachycardias with a widened QRS complex (384 ventricular and 170 supraventricular). The sensitivity of the four consecutive steps was 0.987, and the specificity was 0.965. Current criteria for the differential diagnosis between supraventricular tachycardia with aberrant conduction and ventricular tachycardia are frequently absent or suggest the wrong diagnosis. The absence of an RS complex in all precordial leads is easily recognizable and highly specific for the diagnosis of ventricular tachycardia. When an RS complex is present in one or more precordial leads, an RS interval of more than 100 msec is highly specific for ventricular tachycardia. This new stepwise approach may prevent diagnostic mistakes.
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            New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia.

            We recently reported an ECG algorithm for differential diagnosis of regular wide QRS complex tachycardias that was superior to the Brugada algorithm. The purpose of this study was to further simplify the algorithm by omitting the complicated morphologic criteria and restricting the analysis to lead aVR. In this study, 483 wide QRS complex tachycardias [351 ventricular tachycardias (VTs), 112 supraventricular tachycardias (SVTs), 20 preexcited tachycardias] from 313 patients with proven diagnoses were prospectively analyzed by two of the authors blinded to the diagnosis. Lead aVR was analyzed for (1) presence of an initial R wave, (2) width of an initial r or q wave >40 ms, (3) notching on the initial downstroke of a predominantly negative QRS complex, and (4) ventricular activation-velocity ratio (v(i)/v(t)), the vertical excursion (in millivolts) recorded during the initial (v(i)) and terminal (v(t)) 40 ms of the QRS complex. When any of criteria 1 to 3 was present, VT was diagnosed; when absent, the next criterion was analyzed. In step 4, v(i)/v(t) >1 suggested SVT, and v(i)/v(t) < or =1 suggested VT. The accuracy of the new aVR algorithm and our previous algorithm was superior to that of the Brugada algorithm (P = .002 and P = .007, respectively). The aVR algorithm and our previous algorithm had greater sensitivity (P <.001 and P = .001, respectively) and negative predictive value for diagnosing VT and greater specificity (P <.001 and P = .001, respectively) and positive predictive value for diagnosing SVT compared with the Brugada criteria. The simplified aVR algorithm classified wide QRS complex tachycardias with the same accuracy as standard criteria and our previous algorithm and was superior to the Brugada algorithm.
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              Risk of stroke in patients with atrial flutter.

              Using a Medicare-based retrospective cohort study, the stroke risk in patients with atrial flutter (RR = 1.41) was determined to be greater than that in a control group (RR = 1.00) but less than that in an atrial fibrillation group (RR = 1.64). Furthermore, patients with atrial flutter who subsequently had an episode of atrial fibrillation had a higher risk of stroke (RR = 1.56) than patients with atrial flutter who never had a subsequent episode of atrial fibrillation (RR = 1.11).

                Author and article information

                Cuadernos Hospital de Clínicas
                Cuad. - Hosp. Clín.
                Universidad Mayor de San Andrés, Facultad de Medicina (La Paz, , Bolivia )
                : 60
                : Especial
                : 50-55
                [01] La Paz orgnameInstituto Nacional de Tórax Bolivia marcecarreon@ 123456hotmail.com
                S1652-67762019000300008 S1652-6776(19)06000000008

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 6

                SciELO Bolivia

                CASOS CLÍNICOS

                Atrial flutter,Aleteo auricular,taquicardia con QRS ancho,wide QRS tachycardia,1 to 1 atrioventricular conduction,conducción auriculo ventricular 1 a 1


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