Perdrix-Andujar L, Paziaud O, Ricard G, Diebold B, Le Heuzey J Y
Services de Cardiologie, HEGP, rue Leblanc, Paris
Arch Mal Coeur Vaiss. 2005 Mar;98(3):259-62.
1/1 atrial flutter is a regularly described complication of class I anti-arrhythmics. It is, however, very rarely encountered with class III anti-arrhythmics because prolongation of the atrio-ventricular node refractory period prevents 1/1 nodo-ventricular conduction. There have only been seven cases of 1/1 atrial flutter with amiodarone reported in the literature. Here we describe a new case of 1/1 atrial flutter with amiodarone. Our case clearly illustrates not only the different pro-arrhythmic effects of amiodarone (prolongation of the flutter cycle, and infra-Hissian block) but also the pathophysiological mechanisms possible with 1/1 conduction (prolongation of the flutter cycle, considerable permeability of the AV node). It demonstrates the difficulties of diagnosing such a rhythm disturbance, and that it is sometimes poorly tolerated, as well as underlining the importance of early diagnosis (in this case by oesophageal recording). Preventive treatment of 1/1 flutter can include amiodarone, digitalis, a betablocker or a bradycardic calcium inhibitor.
1:1 房扑是I类抗心律失常药物常见的并发症。然而，III类抗心律失常药物很少出现这种情况，因为房室结不应期的延长会阻止1:1 结室传导。文献中仅报道过7例胺碘酮导致的1:1 房扑。在此，我们描述1例胺碘酮所致1:1 房扑的新病例。我们的病例不仅清楚地说明了胺碘酮不同的促心律失常作用（扑动周期延长和希氏束下阻滞），还展示了1:1 传导可能的病理生理机制（扑动周期延长，房室结显著的通透性）。它显示了诊断这种心律失常的困难，以及它有时耐受性差的情况，同时强调了早期诊断（在本病例中通过食管记录）的重要性。1:1 房扑的预防性治疗可包括胺碘酮、洋地黄、β受体阻滞剂或减慢心率的钙通道阻滞剂。
