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Post-ventricular tachycardia P wave change simulating atrial enlargement
M P Calabrò1, G Oreto, S Consolo
1Department of Pediatrics, Cardiology Service, University of Messina, Italy.
Journal of Electrocardiology
|April 9, 1998
Summary
Prolonged ventricular tachycardia in a child caused temporary P wave abnormalities mimicking atrial enlargement. These electrocardiogram changes resolved spontaneously, highlighting a potential diagnostic pitfall.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Diagnostics
Background:
- Idiopathic ventricular tachycardia can present with complex electrocardiogram (ECG) findings.
- Atrial enlargement is typically diagnosed based on specific P wave characteristics on an ECG.
Observation:
- An abnormal, tall, and peaked P wave (0.5 mV in lead II) was observed in a child with prolonged idiopathic ventricular tachycardia (fascicular tachycardia).
- This P wave abnormality suggested atrial enlargement, but clinical and echocardiographic examinations revealed no underlying cardiac abnormalities.
- The P wave changes persisted for approximately one month before progressively normalizing.
Findings:
- The observed P wave abnormalities were likely secondary to the prolonged tachycardia.
- Atrioventricular dissociation during the tachycardia led to repetitive atrial contractions against closed atrioventricular valves.
- This mechanical stress likely caused temporary stretching of atrial fibers, manifesting as the abnormal P waves.
Implications:
- This case suggests that prolonged ventricular tachycardia can induce a pseudoatrial enlargement pattern on ECG.
- Clinicians should consider tachycardia-induced P wave changes to avoid misdiagnosis of true atrial enlargement.
- Understanding this phenomenon is crucial for accurate interpretation of ECGs in pediatric patients with arrhythmias.