Colin Yeo, MBBS, Martin Green, MD, Robert Lemery, MD, FHRS

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Presentation transcript:

Wide complex tachycardia in a patient with pre-excitation: What is the mechanism? Colin Yeo, MBBS, Martin Green, MD, Robert Lemery, MD, FHRS HeartRhythm Case Reports Volume 3, Issue 6, Pages 315-318 (June 2017) DOI: 10.1016/j.hrcr.2017.02.006 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Electrocardiogram recorded during spontaneous tachycardia in the electrophysiology laboratory. See text for details. HeartRhythm Case Reports 2017 3, 315-318DOI: (10.1016/j.hrcr.2017.02.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 A: Intracardiac electrograms during wide complex tachycardia. There is capture and reset of the atrial (“A”) and ventricular (“V”) electrograms following a late-coupled atrial premature beat (APB) from the high right atrium (HRA). There is also fusion and reset of the QRS on the surface electrocardiogram following the second APB without terminating the wide complex tachycardia. The increased local AV interval of the His bundle (His) and coronary sinus (CS) activation associated with the APBs demonstrate decremental delay. B: Overdrive pacing from the right ventricular apex (RVA) with local capture of the right ventricle and reset of the wide complex tachycardia, including reset of the last paced beat. The last paced and advanced complex is the atrial complex, followed by tachycardia continuing with an atrioventricular complex. HeartRhythm Case Reports 2017 3, 315-318DOI: (10.1016/j.hrcr.2017.02.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Termination of pre-excited tachycardia with 3 mg of intravenous adenosine. HeartRhythm Case Reports 2017 3, 315-318DOI: (10.1016/j.hrcr.2017.02.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Supplemental Figure Baseline electrocardiogram showing sinus rhythm with a normal PR interval without pre-excitation. HeartRhythm Case Reports 2017 3, 315-318DOI: (10.1016/j.hrcr.2017.02.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions