The association of the Wenckebach phenomenon with auricular flutter

Clinical THE

Reports

ASSOCIATION OF THE WENCKEBACH WITH AURICULAR FLUTTER LEON

M.D.,

BROTMACHER, CARDIFF,

PHENOMENON

M.R.C.P.

WALES

flutter, although frequently A URICULAR atrioventricular block, is very rarely

accompanied by some degree of associated with the Wenckebach phenomenon. The only recorded cases in which it was the sole manifestation of a conduction defect are those of Lewis’ and Scherf and Schott.2 The following case is therefore of interest. CASE

REPORT

T.D., a 53-year-old bank manager, who had suffered from attacks of for over twenty years, was admitted to Cardiff Royal Infirmary on July palpitations which had been present for one month. Examination showed minute with dropped beats; blood pressure, 135/90 mm. Hg; congestive ment of the apex beat to the left; and an apical systolic murmur conducted revealed uniform cardiac enlargement.

Fig.

paroxysmal tachycardia 21, 1953, complaining of a heart rate of 140 per cardiac failure; displaceto the axilla. Screening

1.

The electrocardiogram taken on the day of admission shows progressive lengthening P-R interval with failure of the ventricle to respond to every fourth beat (Fig..l). There change with carotid sinus pressure. TWO days later, following administration of Digoxin, From the Cardiac Dept., Received for publication

Royal Infirmary, Feb. 2. 1954.

Cardit?‘. 629

Wales.

of the was no there

630

AMERICAN

HEART

JOURNAL

was 2:l block. The patient was then given quinidine 5 grains three times a day, and tion defect was apparent six days later when sinus rhythm had been restored. He was on Aug. 2, 1953, on quinidine 5 grains twice a day but was readmitted on Aug. 30, auricular flutter, the ventricular response being 1:l. Digitalis therapy was commenced Sept. 2, 19.53, 30 grains quinidine were administered. The Wenckebach phenomenon on the following day to be succeeded on Sept. 4, 19.53, by a higher and more irregular heart block, which persisted until his discharge three weeks later.

no conducdischarged 19.53 with and on reappeared degree of

On neither occasion was the diagnosis made clinically, and it is possible that the combination occurs not infrequently, but is overlooked. I am indebted to Dr. William to publish details of this case.

Phillips

and

to Professor

Harold

Scarborough

of the

Heart

for permission

REFERENCES

1. 2.

Lewis,

T.: The Mechanism and Graphic 1922, Shaw & Sons, p. 261. Scherf, D., and Schott, A.: Extrasystoles Heinemann, Ltd., p. 241.

Registration and

Allied

Arrhythmias,

Beat, London,

ed. 2, London, 1953,

William