Interesting ECG Narrow QRS Tachycardia with Alternate Wide QRS Beats: What is the Mechanism? (original) (raw)
A 44-year old lady underwent electrophysiology study for recurrent palpitations and documented narrow QRS regular tachycardia. The baseline ECG showed subtle preexcitation that was easily manifest on atrial pacing. The retrograde atrial activation sequence during ventricular pacing was eccentric suggesting retrograde conduction over the accessory pathway. A regular narrow QRS tachycardia with cycle length 280 ms was easily inducible on
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Repetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations
Journal of Geriatric Cardiology : JGC, 2018
A 61-year-old female patient suffering from recent onset palpitations and dyspnea on exertion with hypertension and mitral valve prolapse in her past history came to our outpatient department. Echocardiography revealed a mild mitral valve prolapse, slightly decreased left ventricular (LV) function (LV ejection fraction: 51%) and a mild mitral regurgitation. Initial 12-lead ECG showed normal sinus rhythm (NSR) with left anterior hemiblock, upper normal limit (105110 ms) QRS duration and left atrial abnormality (not shown). 24 hour ambulatory ECG monitoring (Figure 1) revealed a great variety of narrow QRS complex arrhythmias at first glance looking like sinus beats alternating either with aberrantly conducted atrial premature beats with hidden low amplitude P waves (Figure 1 first three rhythm strips) or with ventricular premature beats (Figure 1 upper rhythm strip) arranged in a bigeminal pattern. The third rhythm strip of Figure 1 may also be considered a narrow QRS complex tachyc...
Wide complex irregularly regular tachycardia with QRS alternation
Journal of electrocardiology
A 44-year-old white man was referred to our service because of a history of symptomatic rapid palpitations that had begun on January 2007. He had no previous history of syncope or family history of sudden cardiac death. The patient was otherwise well and had not been taking any medications. The electrocardiogram (ECG) recorded during sinus rhythm was within normal limits. A 12-lead ECG was performed during the last episode on July 2007 while he was working at his office. An irregular wide complex tachycardia with varying QRS morphology (left bundle-branch block with an alternating pattern) was documented. The differential diagnoses based on the 12-lead electrocardiogram (ECG) were supraventricular tachycardia with aberrant conduction and QRS alternans, atrial tachycardia with anterograde conduction over an accessory pathway, or ventricular tachycardia. An electrophysiology study was performed and the results are discussed.
Repetitive Narrow QRS Tachycardia With a Group Beating Pattern
2016
Introduction: Dual atrioventricular (AV) node physiology is the substrate for atrioventricular nodal re-entrant tachycardia but electrophysiological manifestation may be different in this group of patients. Case Presentation: A 44-year-old male known case of coronary artery disease from one year ago presented with frequent palpitation that was refractory to anti-arrhythmic drugs. On surface electrocardiogram (ECG), there was one P wave preceding two up to four consecutive QRS complexes. An electrophysiological study was performed and dual AV node physiology in combination with concealed AV node conduction was confirmed. There was unsuccessful radiofrequency ablation (RFA) application in the right posteroseptal area but in second try, successful RFA application was performed in the left posteroseptal area. Conclusions: Dual ventricular response in dual atrioventricular nodal (AVN) physiology is not the usual presentation and may be misdiagnosed with other rhythm disorders. Considering the typical finding on surface ECG and the exact electrophysiological study, the true diagnosis and management could be done in suspected cases.
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