Supraventricular tachycardia and sinus rhythm with contralateral bundle branch block patterns
Seongwook Han1, John M Miller1, Mithilesh Kumar Das1
1Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA.
Korean Circulation Journal
|August 5, 2014
Summary
Contralateral bundle branch block (BBB) aberration during tachycardia with a pre-existing BBB strongly suggests ventricular tachycardia. This case highlights that supraventricular tachycardia with contralateral BBB can occur in patients with abnormal His-Purkinje systems.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Bundle branch block (BBB) aberrations during tachycardia can indicate ventricular tachycardia.
- Pre-existing BBB complicates the interpretation of wide QRS tachycardias.
- Abnormalities in the His-Purkinje system can influence cardiac conduction during arrhythmias.
Purpose of the Study:
- To report a case of supraventricular tachycardia with contralateral bundle branch block aberration.
- To illustrate the diagnostic challenge posed by wide QRS tachycardia in a patient with pre-existing BBB.
- To emphasize the role of an abnormal His-Purkinje system in facilitating contralateral BBB during supraventricular tachycardia.
Main Methods:
- Case report presentation.
- Analysis of electrocardiographic findings during wide QRS tachycardia.
- Review of cardiac electrophysiology principles related to His-Purkinje system function.
Main Results:
- A middle-aged female patient presented with wide QRS tachycardia.
- The patient experienced orthodromic atrioventricular tachycardia with a left BBB aberration.
- This occurred in the context of a pre-existing right BBB, attributed to an abnormal His-Purkinje system.
Conclusions:
- Contralateral BBB aberration during tachycardia in the presence of a pre-existing BBB is a strong indicator of ventricular tachycardia.
- However, supraventricular tachycardia with contralateral BBB can occur in specific scenarios, particularly with underlying His-Purkinje system abnormalities.
- This case underscores the importance of considering His-Purkinje system integrity when interpreting complex wide QRS tachycardias.
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