Recurrent atrial flutter. Treatment with a surgically induced atrioventricular block and ventricular pacing

Synchronized direct countershock, introduced by Lown et al 1 in 1962, is generally accepted as the treatment of choice for the rapid termination of atrial flutter. 2 In 1967, Haft and associates 3 first applied the technique of rapid atrial pacing in the treatment of atrial flutter, and its use was found to be safe even in patients with digitalis-excess. 4,5 Induction of atrial fibrillation has been initiated successfully with a variety of temporary pacemaker methods in the management of supraventricular tachycardias, 6 including atrial flutter. 7 On occasion, patients are encountered who, as a result of unresponsiveness to the intensive medical treatment 8 or intolerance to available antiarrhythmic drugs, continue to experience frequent bouts of atrial tachyarrhythmia. This is accompanied by markedly disabling and even lifethreatening symptoms making the application of other more definitive forms of therapy, such as the surgical induction of atrioventricular (AV) block and ventricular pacing,