Case report: Wide-complex tachycardia one week post-CRT-D implantation in a patient with pre-existing left bundle...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• A 37-year-old female with dilated cardiomyopathy and a left bundle branch block pattern presented with symptoms post-cardiac resynchronization therapy defibrillator (CRTD) implantation.
• The patient experienced palpitations, diaphoresis, and chest discomfort one week after receiving the CRTD.

Observation:

• Electrocardiogram (ECG) revealed a wide-complex tachycardia (WCT) episode during the patient's presentation.
• The WCT spontaneously converted to sinus rhythm.
• Device interrogation findings and electrophysiology study results were crucial for diagnosis.

Findings:

• The wide-complex tachycardia was diagnosed as typical slow-fast atrioventricular nodal re-entrant tachycardia (AVNRT).
• This case underscores the importance of considering AVNRT in the differential diagnosis of WCT in patients with cardiac implantable electronic devices.

Implications:

• Accurate diagnosis of WCT is critical for appropriate management, especially in patients with underlying heart conditions and implanted devices.
• Understanding the interplay between cardiac conditions, device therapy, and tachyarrhythmias can improve patient outcomes.
• This case highlights the need for a systematic approach to diagnosing WCT, integrating clinical presentation, ECG findings, device data, and electrophysiology studies.