Key result
Class 1C antiarrhythmic drugs without concomitant AV nodal blocking agents can lead to atrial flutter with 1:1 AV conduction presenting as wide complex tachycardia with rates >200/minute.
Case Report (n=2)
Illustrates the critical importance of coadministering an AV nodal blocking agent with class IC antiarrhythmic agents in patients with atrial fibrillation to prevent 1:1 conducted atrial flutter.
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May warrant AV nodal blocker co-prescription with class 1C agents in AF; leaves open generalizability beyond this case.
We present two patients with paroxysmal atrial fibrillation on class 1C antiarrhythmic drugs without concomitant atrioventricular (AV) nodal blocking agents who developed atrial flutter with 1:1 AV conduction. Their electrocardiogram revealed wide complex tachycardia with rates >200/minute. Atrial flutter with 1:1 conduction in the presence of class IC antiarrhythmic drugs may present a diagnostic challenge. These cases illustrate the importance of coadministering an AV nodal blocking agent with class IC antiarrhythmic agents in patients with atrial fibrillation. The differential diagnosis of wide complex tachycardia in patients taking class IC agents should include atrial flutter with 1:1 AV conduction.
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Bhardwaj et al. (2013) conducted a case report in Paroxysmal atrial fibrillation (n=2). Class 1C antiarrhythmic drugs without AV nodal blocking agents was evaluated on Development of atrial flutter with 1:1 AV conduction presenting as wide complex tachycardia. Class 1C antiarrhythmic drugs without concomitant AV nodal blocking agents can lead to atrial flutter with 1:1 AV conduction presenting as wide complex tachycardia with rates >200/minute.
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