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Right Atrial Stimulation in the Treatment of Atrial Flutter

HOWARD J. ZEFT, M.D.; FRED R. COBB, M.D.; MENASHE B. WAXMAN, M.D.; NOEL C. HUNT, M.D.; and JAMES J. MORRIS JR., M.D.
Ann Intern Med. 1969;70(3):447-456. doi:10.7326/0003-4819-70-3-447
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SUMMARY:

The use of right atrial stimulation in the treatment of atrial flutter was evaluated in 10 patients. Atrial flutter was present in these patients from 6 to 96 hr before the procedure. Eight patients were receiving digitalis preparations. In seven patients a unipolar platinum-tipped electrode was positioned in the right atrium by monitoring the intra-atrial electrocardiogram; in three patients a bipolar pacing catheter was positioned in the right atrium under fluoroscopic guidance. Atrial stimulation was performed utilizing either a battery-powered or electrically powered pulse generator. Right atrial stimulation was performed at 180/min in seven patients and 400 to 600/min in three patients. Right atrial stimulation produced conversion to a stable sinus rhythm in seven patients and a transient sinus rhythm in an additional patient. In all but one patient transient unstable atrial fibrillation was observed immediately before conversion to a sinus mechanism. Postconversion arrhythmias or complications directly attributed to the procedure were not observed. In certain patients with atrial flutter-especially those unable to tolerate anesthesia, large doses of antiarrhythmic drugs, or withdrawal from digitalis—atrial stimulation seems to be the initial treatment of choice.

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