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- W2736100081 abstract "In spite of the available clinical and electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardias, distinguishing orthodromic supraventricular tachycardias is still a challenge. We present a case of a 63-year old patient admitted in our clinic after experiencing two episodes of syncope. Echocardiography showed left ventricular hypertrophy, grade 1 diastolic dysfunction and left atrial enlargement. A Holter monitoring revealed episodes of atrial fibrillation and paroxysmal narrow QRS tachycardia alternating with wide QRS tachycardia (170-180 bpm). During an electrophysiology study we induced self-limiting orthodromic supraventricular tachycardias with narrow and left bundle branch block patterns. Retrograde mapping near the mitral annulus identified a concealed accessory posteroseptal by-pass tract which was successfully ablated. After the procedure the patient developed atrial flutter and atrial fibrillation with rapid ventricular response (196 beats per minute) with a 3.9 s post-tachycardia pause. The patient underwent implantation of a cardiac pacemaker which allowed us to start antiarrhythmic treatment with amiodarone. This case shows that occult accessory posteroseptal by-pass tracts can have a late-onset presentation in a 63-year old male and explains why latent rhythm disturbances require a step-by-step medical approach." @default.
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- W2736100081 date "2017-06-01" @default.
- W2736100081 modified "2023-09-26" @default.
- W2736100081 title "Diagnosis and management of a wide QRS regular tachycardia" @default.
- W2736100081 doi "https://doi.org/10.22551/2017.15.0402.10101" @default.
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