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Patient
36-year-old man with a tetralogy of Fallot; repair surgery at the age of 3 years; second surgery with implantation of a pulmonary bioprosthesis at the age of 21; hospitalization for cardiac decompensation;
Trace
Bradycardia (45 beats/minute) with typical common flutter pattern; repetition of regular, all identical F waves; sawtooth pattern in inferior leads (fast ascending line, peaked summit, slower descending line, with no return to isoelectric line); poorly visible and low voltage F waves in lead I, positive in V1 and negative in V6; the duration of the atrial cycle is 210 ms (rate approximately 290 beats/minute); variable atrioventricular conduction (1:8, 1:6, 1:5); in this patient, atrioventricular conduction appears to be altered, explaining the ratio between the number of F waves and the number of QRS complexes; right bundle branch block with wide QRS (175 ms), right axis, delayed intrinsicoid deflection in V1, V2; probable right ventricular hypertrophy;
Exergue
Patients with congenital heart disease who have undergone surgery with right lateral atriotomy preferentially present 2 types of organized atrial arrhythmias: common isthmus-dependent flutter and scar-related atrial flutter. The duration of the atrial reentry cycle is generally shorter (faster atrial rate) for a scar-related atrial flutter than for an isthmus-dependent flutter, the circuit being shorter.
The surgical repair of a tetralogy of Fallot has less detrimental effects on the atrial mass than a Senning, Mustard or Fontan type intervention. However, there is a high prevalence of atrial rhythm disorders observed on the long term after the surgery.