A wobble tachycardia… supraventricular, ventricular or both?

Area of Science:

• Cardiology
• Electrophysiology
• Internal Medicine

Background:

• Wide complex tachycardia (WCT) presents a diagnostic challenge, as it can originate from either supraventricular or ventricular sources.
• A baseline right bundle branch block can further complicate the differentiation of WCT morphology.

Observation:

• A 77-year-old male patient with a history of ischemic heart disease and pre-existing right bundle branch block presented with a regular, wide complex tachycardia exhibiting right bundle branch block morphology.
• The tachycardia was hemodynamically well-tolerated.

Findings:

• The case underscores the importance of considering ventricular tachycardia in the differential diagnosis of WCT, even with apparent benign features.
• Discussion includes the utility and limitations of established diagnostic criteria for distinguishing ventricular tachycardia.

Implications:

• Accurate differentiation of WCT origin is crucial for appropriate patient management and therapeutic decisions.
• This case emphasizes the need for a thorough diagnostic approach to WCT in patients with underlying cardiac conditions.