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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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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author Behzad B. Pavri
Eitan Frankel
author_facet Behzad B. Pavri
Eitan Frankel
author_sort Behzad B. Pavri
collection DOAJ
description 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.
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institution Kabale University
issn 1082-720X
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language English
publishDate 2025-05-01
publisher Wiley
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series Annals of Noninvasive Electrocardiology
spelling doaj-art-40b8b27fd7d4418db7f5c4ef24d30ebe2025-08-20T03:48:23ZengWileyAnnals of Noninvasive Electrocardiology1082-720X1542-474X2025-05-01303n/an/a10.1111/anec.70069Serendipitous SupernormalityBehzad B. Pavri0Eitan Frankel1Thomas Jefferson University Hospital Philadelphia Pennsylvania USAThomas Jefferson University Hospital Philadelphia Pennsylvania USAABSTRACT 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.https://doi.org/10.1111/anec.70069atrioventricular node ablationatypical atrial fluttersupernormal conduction
spellingShingle Behzad B. Pavri
Eitan Frankel
Serendipitous Supernormality
Annals of Noninvasive Electrocardiology
atrioventricular node ablation
atypical atrial flutter
supernormal conduction
title Serendipitous Supernormality
title_full Serendipitous Supernormality
title_fullStr Serendipitous Supernormality
title_full_unstemmed Serendipitous Supernormality
title_short Serendipitous Supernormality
title_sort serendipitous supernormality
topic atrioventricular node ablation
atypical atrial flutter
supernormal conduction
url https://doi.org/10.1111/anec.70069
work_keys_str_mv AT behzadbpavri serendipitoussupernormality
AT eitanfrankel serendipitoussupernormality