[Supraventricular tachycardia with wide QRS complexes during Vaughan-Williams class I anti-arrhythmic treatment. Diagnostic and therapeutic implications].
The authors report 8 cases of regular tachycardia with wide QRS complexes during treatment with Vaughan-Williams class 1 antiarrhythmic drugs. These antiarrhythmics, prescribed to prevent atrial fibrillation (3 patients) and atrial flutter (5 patients), were flecainide in 4 cases, propafenone in 2 cases and cibenzoline and hydroquinidine respectively associated with digitoxine and propranolol. These wide complex tachycardias were regular atrial tachycardias with 1/1 conduction to the ventricle. The action of the drug, more pronounced on intra-atrial conduction velocities than on atrioventricular node refractoriness resulted in transformation of flutter at 300 cycles/min with 2/1 conduction and a ventricular rate of 150 cycles/min to atrial flutter at 210 cycles/min with 1/1 ventricular conduction. This acceleration of the ventricular rate was accompanied by widening of the QRS complex. Using the new ventricular tachycardia criteria recently published by Brugada resulted in a diagnostic error in 7 out of the 8 cases. The recording of a wide QRS complex tachycardia in a patient on class 1 antiarrhythmic therapy for an atrial arrhythmia should alert the physician to 1/1 atrial tachycardia despite morphological electrocardiographic criteria of ventricular tachycardia. The 1/1 atrial tachycardia may be poorly tolerated and require emergency treatment. The preventive association of a drug which slows conduction through the atrioventricular node is not always effective.
Aouate
P
P
Centre médico-chirurgical, Villiers-Saint-Denis, Ivry-sur-Seine.
Frank
R
R
Fontaine
G
G
Tonet
J
J
Tageddine
R
R
Benassar
A
A
Turlure
A
A
Jacquemin
M
M
Laborde
J P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000517:prevention & control; D001282:Atrial Flutter / Q000517:prevention & control; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D005424:Flecainide / Q000009:adverse effects / Q000627:therapeutic use; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011405:Propafenone / Q000009:adverse effects / Q000627:therapeutic use; D013617:Tachycardia, Supraventricular / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control
D000889:Anti-Arrhythmia Agents; D007093:Imidazoles; D011405:Propafenone; D005424:Flecainide; C032151:cifenline
Tachycardie supraventriculaire à QRS larges survenant sous antiarythmique de la classe 1 de Vaughan-Williams. Implications diagnostiques et thérapeutiques.