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Wide QRS complex tachycardia due to typical atrial flutter with accessory pathway conduction
D Prochnau1, L Gabbert2, V Sauer2
1Department of Internal Medicine I, Sophien- and Hufeland-Hospital Weimar, Henry-van-de-Velde-Straße 2, 99425, Weimar, Germany. d.prochnau@klinikum-weimar.de.
Herzschrittmachertherapie & Elektrophysiologie
|July 9, 2021
Summary
A 62-year-old male with wide QRS tachycardia was diagnosed with atrial flutter and pre-excitation. Ajmaline unmasked the flutter, and electrophysiological study revealed an accessory pathway. Both conditions were successfully ablated in one procedure.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Wide QRS complex tachycardia can present diagnostic challenges, sometimes masking underlying arrhythmias.
- Ajmaline is a Class Ia antiarrhythmic agent used diagnostically to unmask concealed accessory pathways.
Observation:
- A 62-year-old male presented with regular wide QRS complex tachycardia.
- Ajmaline administration revealed underlying atrial flutter with variable QRS morphologies.
- Electrophysiology study demonstrated progressive pre-excitation with decremental atrial stimulation and spontaneous typical atrial flutter with pre-excited QRS complexes.
Findings:
- The diagnostic challenge of wide QRS tachycardia was resolved by ajmaline, revealing atrial flutter.
- An accessory pathway capable of pre-excitation was identified during electrophysiological study.
- Successful simultaneous ablation of both the accessory pathway and atrial flutter was achieved.
Implications:
- This case highlights the diagnostic utility of ajmaline in challenging tachycardia presentations.
- Simultaneous ablation offers a potentially curative and efficient treatment strategy for combined accessory pathway and atrial flutter.
- Understanding these complex arrhythmias is crucial for effective patient management and improved outcomes.
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