Serendipitous Supernormality

ABSTRACT We describe a patient who underwent AV node modification to create complete heart block in the setting of incessant, ablation‐and‐drug‐refractory, symptomatic atypical atrial flutter. His dual chamber defibrillator (previously implanted for resuscitated cardiac arrest) was programmed to the...

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Bibliographic Details
Main Authors: Behzad B. Pavri, Eitan Frankel
Format: Article
Language:English
Published: Wiley 2025-05-01
Series:Annals of Noninvasive Electrocardiology
Subjects:
Online Access:https://doi.org/10.1111/anec.70069
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Summary:ABSTRACT We describe a patient who underwent AV node modification to create complete heart block in the setting of incessant, ablation‐and‐drug‐refractory, symptomatic atypical atrial flutter. His dual chamber defibrillator (previously implanted for resuscitated cardiac arrest) was programmed to the VVIR mode at a faster pacing rate of 85 bpm. Serendipitously, this rate was an almost exact factorial of his flutter rate of 250–260 bpm. This resulted in every 6th flutter wave falling in the supernormal period, resulting in fixed‐coupled supraventricular bigeminy and trigeminy in the setting of complete heart block. Reprogramming the pacing rate to 75 bpm abolished bigeminy and trigeminy.
ISSN:1082-720X
1542-474X