![]() Many mechanisms have been proposed to explain tachycardia with alternant QRS complexes.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 In a recent review of the literature, Rosenbaum et al 2 made the assumption that bidirectional tachycardia is a supraventricular tachycardia with permanent aberrant conduction in the right bundle branch and alternate conduction defects in the two divisions of the left bundle branch. When atrial flutter is diagnosed, three options are available to restore sinus rhythm: (1) administer an antiarrhythmic drug (2) initiate DC cardioversion or (3) initiate rapid atrial pacing to terminate the atrial flutter (fig 4 ). The electrocardiogram taken on admission showed two DISCUSSION Physical examination was essentially negative except for a tachycardia of 150 beats per minute. Atrial flutter is similar to atrial fibrillation, a common disorder. ![]() Atrial flutter is a type of heart rhythm disorder ( arrhythmia) caused by problems in the heart's electrical system. This causes the heart to beat in a fast, but usually regular, rhythm. He was relatively well until about 30 minutes preceding admission when he suddenly developed a non-radiating substernal pain associated with marked diaphoresis and dyspnea. In atrial flutter, the heart's upper chambers (atria) beat too quickly. He had been on a maintenance dose of digoxin 0.25 mg daily for this period. The patient was an 81-year-old man known to have arteriosclerotic heart disease for the past ten years. The constant and stable duration of all the ventricular beats with LBBB pattern, preceded and followed by normal ventricular complexes along with changing conduction ratios of 3:1 and 2:1 LBBB suggested Mobitz type II-like response in the LBB. ![]() The regularity of the R-R interval, occurrence of two consecutive aberrant QRS complexes of similar duration without altering the R-R interval, and the conversion of the tachycardia to normal sinus rhythm with normal QRS complexes by application of carotid massage, all lend support to a unifocal, supraventricular origin of tachycardias with alternant QRS complexes. The assumption is made that this uncommon tachyarrhythmia occurs only in hearts with latent localized organic His-Purkinje system disturbance and made evident by the effect of supraventricular tachycardia. This article presents the data of a patient who manifested the phenomenon of intermittent and transient left bundle branch block (LBBB) and subsequently Mobitz type II-like block in the left bundle branch (LBB). ![]()
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