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A 33-Year Old with Wide Complex Tachycardia
John Larson1, Michael S Lloyd1
1Division of Cardiac Electrophysiology, Department of Medicine, Emory University, Atlanta, GA, USA.
Cardiac Electrophysiology Clinics
|August 11, 2026
Summary
A patient with wide complex tachycardia was diagnosed with a nodo-ventricular pathway. Radiofrequency ablation successfully eliminated pre-excitation, resolving symptoms and preventing recurrence.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Wide complex tachycardia (WCT) can be challenging to diagnose and manage.
- Pre-excitation syndromes require precise electrophysiological identification for effective treatment.
Purpose of the Study:
- To diagnose and treat a rare case of wide complex tachycardia caused by a nodo-ventricular pathway.
- To evaluate the efficacy of electroanatomic mapping and radiofrequency ablation for this specific arrhythmia.
Main Methods:
- Electrophysiology (EP) study including atrial and ventricular pacing protocols.
- Electrocardiographic (ECG) analysis for pre-excitation and A-V dissociation.
- Adenosine administration to assess pathway response.
- 3D electroanatomic mapping to identify earliest ventricular activation.
- Radiofrequency catheter ablation targeting the identified pathway.
Main Results:
- EP study revealed pre-excitation and A-V dissociation during induced tachycardia.
- Para-hissian pacing excluded a septal pathway.
- Adenosine administration temporarily abolished pre-excitation, supporting a nodo-ventricular pathway diagnosis.
- Electroanatomic mapping pinpointed the earliest activation site in the slow pathway region.
- Ablation at the target site successfully eliminated all pre-excitation.
Conclusions:
- A nodo-ventricular pathway was confirmed as the cause of the patient's wide complex tachycardia.
- Radiofrequency ablation in the slow pathway region is an effective treatment for this rare condition.
- Successful ablation resulted in long-term symptom resolution and freedom from arrhythmia.
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