A broad complex tachycardia suggesting global ischemia or repolarization abnormalities.
Charis Gkalapis1, Marios Papadakis2, Claire A Martin3
1Department of Electrophysiology-Cardiology Klinikum Vest Recklinghausen Germany.
Journal of Arrhythmia
|August 13, 2021
Summary
This case study highlights a rare cavotricuspid isthmus-dependent atrial flutter (AFL) with 1:1 conduction. This condition mimicked ventricular tachycardia due to a distinct "shark fin" ECG pattern.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Atrial flutter (AFL) can present with varied electrocardiogram (ECG) findings.
- The cavotricuspid isthmus (CTI) is a common substrate for typical AFL.
- Distinguishing AFL from ventricular tachycardia (VT) is critical for appropriate management.
Purpose of the Study:
- To describe a unique case of CTI-dependent AFL with 1:1 atrioventricular conduction.
- To illustrate the
- shark fin phenomenon"
- (pronounced ST-segment elevation in aVR) associated with this AFL presentation.
- To emphasize the importance of recognizing this ECG pattern to avoid misdiagnosis as VT.
Main Methods:
- Case report presentation.
- Review of ECG findings.
- Differential diagnosis of broad complex tachycardias.
Main Results:
- The patient presented with a cavotricuspid isthmus-dependent atrial flutter.
- A 1:1 atrioventricular conduction was observed.
- A prominent 'shark fin' pattern (ST-segment elevation in aVR) was noted on the ECG.
- This ECG pattern mimicked a broad complex tachycardia of ventricular origin.
Conclusions:
- The 'shark fin phenomenon' in the context of 1:1 conduction can represent CTI-dependent AFL.
- Accurate ECG interpretation is crucial for differentiating this AFL from ventricular tachycardia.
- Recognition of this specific ECG manifestation aids in timely and correct diagnosis and treatment.
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