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. 2021 Nov 23;38(1):115-117.
doi: 10.1002/joa3.12657. eCollection 2022 Feb.

Diagnosing a wide complex tachycardia using basic electrophysiologic properties of the cardiac conduction system

Gregory P Siroky  1 , Davendra Mehta  1
Affiliations

Diagnosing a wide complex tachycardia using basic electrophysiologic properties of the cardiac conduction system

Gregory P Siroky et al. J Arrhythm. .

Abstract

65-year-old man with a history of coronary artery disease s/p percutaneous coronary intervention to the left anterior descending artery and atrial fibrillation s/p recent (<3 months) pulmonary vein isolation presented to the emergency department with symptoms of palpitations for 1 day after admittedly forgetting to take his medications found to be in a wide complex tachycardia. We discuss a stepwise approach using properties of the conduction system to diagnose the patient's tachycardia.

Keywords: Mobitz I AV block; atrial tachycardia; electrocardiogram; linking; phase 3 block.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
(A) Presenting ECG. (B) ECG obtained 10 min after administration of IV metoprolol
FIGURE 2
FIGURE 2
Ladder diagram demonstrating the Mobitz I AV block and phase 3 block of the RB with perpetuation of RBBB due to transseptal, retrograde concealed conduction (linking). A, atrium; AVN, atrioventricular node; BB, bundle branches; LB, left bundle; RB, right bundle
See this image and copyright information in PMC

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References

    1. Ho R. Electrophysiology of Arrhythmias. Philadelphia, PA: Wolters Kluwer; 2020.
    1. Liang J, Dixit S. Early recurrences during the blanking period after atrial fibrillation ablation. J Atr Fibrillation. 2018;10(5):1726. - PMC - PubMed
    1. Hung Y, Chang S‐L, Lin W‐S, Lin W‐Y, Chen S‐A. Atrial tachycardias after atrial fibrillation ablation: how to manage? Arrhythm Electrophysiol Rev. 2020;9(2):54–60. - PMC - PubMed
    1. Kashou AH, Noseworthy PA, DeSimone CV, Deshmukh AJ, Asirvatham SJ, May AM. Wide complex tachycardia differentiation: a reappraisal of the state‐of‐the‐art. J Am Heart Assoc. 2020;9(11):e016598. - PMC - PubMed
    1. Seibolt L, Maestas C, Lazkani M, Fatima U, Loli A, Chesser M. Rate‐related left bundle branch block and cardiac memory in a patient with bradycardia: case report and literature review. Clin Cardiol. 2018;41:1097–102. - PMC - PubMed