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Editor: Mark A. Wood, M.D.
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Wide Complex Tachycardia in 42 Year Old Woman
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Mark A. Wood, M.D.,
Associate Professor of Medicine/Cardiology,
Cardiology,
Virginia Commonwealth University's Medical College of Virginia,
Richmond, VA.
Presentation:
A 42 year old woman is referred for electrophysiologic testing . She has a 3 year history of recurrent sustained palpitations and a wide complex tachycardia documented on an ER visit (Figure 1). The tachycardia terminated with adenosine and the patient had reduced frequency of symptoms on diltiazem as an outpatient but sought curative therapy. She has sleep apnea but no structural heart disease and her ejection fraction is normal. In the EP lab her clinical tachycardia was easily inducible but only with ventricular extrastimuli. The tachycardia was not reset by even very premature right atrial extrastimuli but terminated with atrial extra-stimuli for the distal coronary sinus (Figure 2). There was no ventricular preexcitation with burst pacing from the right atrium.
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Figure 1.
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12 lead ECG of wide complex tachycardia |
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Figure 2.
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HRA -high right atrium, d- distal, m - mid, p - proximal, CS - coronary sinus, RVA - right ventricular apex |
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Question:
What is the mechanism of this patient’s tachycardia?Answer Here! |
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