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Failed Pacemaker Detection of Flecainide-Induced Atrial Flutter With One-to-One Atrioventricular Conduction

Year: 2025

Type: article

Abstract: BACKGROUND: Antiarrhythmic drugs commonly used in atrial fibrillation management are associated with variable clinical responses and proarrhythmic properties. CASE SUMMARY: A 53-year-old woman presented with a wide-complex tachycardia. Electrocardiogram after amiodarone administration revealed a flecainide-induced atrial flutter with 1:1 AV conduction and pacemaker interrogation revealed undersensing of presenting ventricular rates at 230 beats/min. DISCUSSION: Flecainide therapy has been well-described to organize AF into AFL that is predisposed to 1:1 AV conduction. This case underscores a concerning limitation in the detection of potentially life-threatening arrhythmias with some nominal pacemaker devices.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.103365

Authors: Paul J. Wurtz, Joseph Pearman, Kelvin N.V. Bush

Institution: Brooke Army Medical Center

Language: English

Topic: Cardiac pacing and defibrillation studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850