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  • Title: [1:1 atrial flutter in an elderly patient: one of the methods of discovering Wolff-Parkinson-White syndrome. Apropos of a case in an adult].
    Author: Parmeggiani L, Adamec R, Perrenoud JJ.
    Journal: Arch Mal Coeur Vaiss; 1984 Jan; 77(1):111-7. PubMed ID: 6422886.
    Abstract:
    Atrial flutter with 1:1 atrioventricular conduction giving rise to a ventricular rhythm of 240/min in an 80 year old man was the first sign of the Wolff-Parkinson-White syndrome; all previous electrocardiogrammes had shown no evidence of pre-excitation. It was only on the fifth day of hospitalisation that the ECG showed a short PR interval with a delta wave. This case illustrates that: --all supraventricular arrhythmias with abnormally high ventricular rates (over 220/min in adults) should alert to the possibility of an accessory atrioventricular pathway; --rapid atrioventricular conduction may be the first sign of an accessory pathway; --the differential diagnosis lies between an accessory atrioventricular pathway and an atriohisian tract; --digitalis, which may shorten the refractory period of the accessory pathway, is contraindicated in patients with a Kent bundle.
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