Atrial flutter and post-tachycardia syncope

Tracing
N° 65
Patient
87-year-old man with ischemic cardiomyopathy and left bundle branch block; hospitalization for repeated syncope; recording of a long tracing (lead II over 1 minute); the patient presented a near-syncope during the recording of the tracing;
Atrial flutter and post-tachycardia syncope
Comments

In this patient, two main hypotheses could initially be evoked to explain the occurrence of sudden syncope: 1) a paroxysmal complete atrioventricular block suggested by the presence of the left bundle branch block; 2) a common ventricular rhythm disorder in patients with ischemic cardiomyopathy. The recorded tracing reveals a third mechanism: a post-tachycardia sinus pause. This type of tracing therefore corresponds to a variant of atrial disease combining atrial fibrillation/flutter episodes and significant pause occurring only at the time of the end of the arrhythmia. This patient underwent a common flutter ablation, a relatively standardized procedure with a success rate exceeding 90%, which eliminated the syncopal episodes.

Epigraph
The combination of atrial flutter and post-tachycardia sinus pause is a particular form of atrial disease.
Atrial flutter and post-tachycardia syncope