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. 2023 Feb 17:11:101766.
doi: 10.1016/j.jaccas.2023.101766. eCollection 2023 Apr 5.

Wide Complex Tachycardia: The Answer Is in Front of You

Arjun B Gupta  1 , Huazhen Chen  1 , Marc A Miller  1
Affiliations

Wide Complex Tachycardia: The Answer Is in Front of You

Arjun B Gupta et al. JACC Case Rep. .

Abstract

Supraventricular tachycardia with aberrancy and ventricular tachycardia can often be differentiated on the basis of subtle findings. We present an electrocardiogram with findings of Coumel's sign, which is diagnostic of atrioventricular re-entrant tachycardia using an accessory pathway. (Level of Difficulty: Advanced.).

Keywords: Coumel’s sign; atrioventricular reentrant tachycardia; supraventricular tachycardia.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
The Patient's Presenting ECG
Figure 2
Figure 2
Mechanism of Coumel’s Sign Orthodromic atrioventricular reentrant tachycardia using the left-sided accessory pathway in the absence and presence of left bundle branch block. On the right, with the left bundle branch block, the circuit passes through the right bundle and takes longer to reach the left-sided accessory pathway. Printed with permission from © 2022 Mount Sinai Health System. AV = atrioventricular node; SA = sinoatrial node.
See this image and copyright information in PMC

References

    1. Coumel P., Attuel P. Reciprocating tachycardia in overt and latent preexcitation. Influence of functional bundle branch block on the rate of the tachycardia. Eur J Cardiol. 1974;1(4):423–436. - PubMed
    1. Lehmann M.H., Denker S., Mahmud R., Addas A., Akhtar M. Linking: a dynamic electrophysiologic phenomenon in macroreentry circuits. Circulation. 1985;71(2):254–265. - PubMed

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