Digitalis-induced double atrioventricular nodal rhythm associated with electrical alternans.

An instance of digitalis-induced double atrioventricular nodal rhythm associated with ventricular electrical alternans has been described . To the knowledge of the author, it is the first such combination reported. One atrioventricular nodal pacemaker (group A) produces non-paroxysmal atrioventricular nodal tachycardia and the other pacemaker (group B) produces atrioventricular escape rhythm with electrical alternans. The influence of digitalis and hypokalemia in relation to such cardiac arrhythmia has been discussed. The necessity of early recognition of digitalis intoxication in elderly patients who develop non-paroxysmal atrioventricular nodal tachycardia and atrioventricular nodal escape rhythm during digitalization has been emphasized. The appearance of electrical alternans in this case is thought to be related to digitalis intoxication.