Key result
Diltiazem fails to prevent 1:1 atrial flutter conduction during chronic flecainide therapy for paroxysmal AF.
Why the study?
No guidance exists on the type or strength of atrioventricular nodal blockade required to prevent 1:1 atrial flutter conduction when co-administered with class 1C anti-arrhythmics.
Does diltiazem prevent 1:1 conduction of atrial flutter in patients treated with flecainide for paroxysmal atrial fibrillation?
Case Report (n=1)
No
Does diltiazem prevent 1:1 conduction of atrial flutter in patients treated with flecainide for paroxysmal atrial fibrillation?
This case report highlights that diltiazem may fail to prevent 1:1 atrial flutter conduction in patients treated with flecainide, suggesting a need for clearer guidance on AV nodal blockade.
Answers are grounded in this paper and cite their sources.
Diltiazem may fail to prevent 1:1 flutter on flecainide; hypothesis-generating for optimal AV nodal blockade strategies.
BACKGROUND: Atrial flutter with 1:1 conduction to the ventricles is a dangerous cardiac arrhythmia. Contemporary guidelines recommend atrioventricular nodal blocking agents should be co-administered with class 1C anti-arrhythmics, as prophylaxis against 1:1 flutter. No guidance is provided on the type or strength of atrioventricular nodal blockade required, and in practice, these agents are frequently prescribed at low dose, or even omitted, due to their side effect profile. CASE PRESENTATION: A 62 year old Caucasian man with a history of paroxysmal atrial fibrillation treated with flecainide, presented with atrial flutter with 1:1 conduction to the ventricles and was cardioverted. Diltiazem was added to prevent this complication and he again presented with atrial flutter with 1:1 conduction to the ventricles, despite prophylaxis with coadministration of diltiazem. CONCLUSIONS: This case report demonstrates failure of diltiazem to prevent 1:1 flutter in a patient chronically treated with flecainide for paroxysmal atrial fibrillation.
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Tiver et al. (2023) conducted a case report in Atrial flutter with 1:1 conduction (n=1). Diltiazem was evaluated on Recurrence of atrial flutter with 1:1 conduction. Diltiazem 180 mg daily failed to prevent recurrent atrial flutter with 1:1 conduction in a patient chronically treated with flecainide for paroxysmal atrial fibrillation.
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