Atrial flutter with complete heart block.

The association of atrial flutter and complete heart block is very uncommon. Amongst 168 cases of atrial flutter described by Willius (1927) only one had complete heart block, and in a review of 20,000 electrocardiograms Di Gregorio and Crawford (1939) found the combined dysrhythmia only twice. Campbell (1944) in his analysis of 64 cases of heart block does not mention the association, and of the large series of 251 patients with complete heart block discussed by Penton et al. (1956) four had atrial flutter. In a recent review, Korst and Wasserburger (1954) mentioned 72 cases of whom 57 were men: the ages ranged from 14 to 84 years and the great majority occurred in the sixth and later decades. We have found reports of only 14 cases under fifty, 9 men and 5 women, and of these 10 showed evidence of organic heart disease. The four cases forming the subject of this report are men under fifty years of age, and the third and fourth have no evidence of organic heart disease.