Why the study?
A slow, regular ventricular response during typical atrial flutter can conceal complete atrioventricular block, complicating diagnosis in decompensated heart failure patients.
Case Report (n=1)
A slow, regular ventricular response in typical atrial flutter may mask concealed complete AV block, which can be successfully managed with ablation and left bundle branch area pacing-optimized CRT to improve heart failure symptoms.
A slow, regular ventricular response during typical atrial flutter, especially with alternating bundle branch block, should raise suspicion of concealed complete atrioventricular block. We report a 73-year-old man with decompensated heart failure (ejection fraction 25%) in whom typical flutter masked advanced infra-Hisian block. Cavotricuspid isthmus ablation terminated the flutter and unmasked complete atrioventricular block (QRS 160 ms). Left bundle branch area pacing-optimized cardiac resynchronization therapy with intentional anodal capture narrowed the QRS to 90 ms, with early clinical improvement.
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Vo et al. (2026) conducted a case report in Decompensated heart failure and typical atrial flutter with concealed complete atrioventricular block (n=1). Cavotricuspid isthmus ablation and left bundle branch area pacing-optimized cardiac resynchronization therapy was evaluated.
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