Inspired by Vince D.
70 year old man with recent diagnosis of hyperthyroidism walks into the ED with palpitations. Has had them since the hyperthyroidism started but states something changed a few hours ago and now he feels a bit light headed with them.
Vitals are all stable, and the patient looks well.
His ECG looks like this:
Thoughts:
How often does adenosine convert Atrial Flutter?
About Andy Neill
It looks like a PVC interrupts the flutter circuit, pretty neat.
This is neat and I have thought of it at times and done it once or twice. But then I have started thinking I might be skyrocketing an (atrial) thrombus -- they say it’s the converting to sinus process that bears the most risk, not the electroconversion. Call me a wooze but I don’t think I can do this with a genuine smile until the statistics tell me it’s ok!
It wasn’t my intention to cardiovert them -- it just happened
It’s happened for my patient also so (sh)it happens… But I’m just basing on anecdotal experience and would love to have comments from someone who knows better?
Looks like a 2002 study found a 0.72% overall complication rate, comparable to the conversion of atrial fibrillation (0.46%, no significant difference).
http://content.onlinejacc.org/article.aspx?articleid=1130325
Conclusions:
The INR should be ≥2.5 at the time of cardioversion if the duration of AF is uncertain or >2 days. Cardioversion of atrial flutter presents similar risks and requires similar anticoagulation.
It happened on a patient we were treating today! -- the first time in my experience and that of my colleagues (which probably adds up into the hundreds)