Administering AV nodal blocking agents to patients with atrial flutter and an accessory pathway can cause life-threatening 1:1 conduction and hemodynamic instability.
Supports caution with AV nodal blockers in atrial flutter and accessory pathway; single case report leaves open prospective validation.
A middle-aged man with no previous cardiac history was admitted to the hospital being treated for thigh cellulitis, during his stay he developed palpitations and tachycardia which on initial ECG showed atrial flutter with a 2:1 AV block and evidence of an accessory pathway. He was subsequently given AV nodal blocking agents in the form of beta-blockers (bisoprolol) to slow his heart rate down; unfortunately, this led to hemodynamic instability due to 1:1 conduction of the atrial flutter down the accessory pathway. This case report demonstrates the importance of recognising pre-excitation on an ECG and the potential adverse effect of administering AV nodal blockade.
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Ali et al. (2024) studied this question.
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