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Wide QRS arrhythmia: what is the diagnosis?
  1. Cátia Costa Oliveira1,2,3,
  2. Sérgia Rocha1,
  3. Sónia Magalhães1
  1. 1 Hospital de Braga, Braga, Portugal
  2. 2 University of Minho, School of Medicine, Braga, Portugal
  3. 3 ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
  1. Correspondence to Dr Cátia Costa Oliveira, Hospital de Braga, Braga, Portugal; catiaandreiaoliveira{at}gmail.com

https://doi.org/10.1136/emermed-2021-211254

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    Clinical Introduction

    A 45-year-old man with history of unspecified intermittent arrhythmia presented to the ED with palpitations and dizziness. He was conscious with systolic BP of 90 mm Hg and HR of 180 to 220 beats/minute. The remaining physical examination was unremarkable. Figure 1 exhibits his initial ECG.

    Figure 1

    Initial ECG showing a wide and irregular tachycardia.

    Question

    What is the most probable diagnosis?

    1. Ventricular tachycardia

    2. Pre-excited atrial fibrillation

    3. Antidromic atrioventricular re-entrant tachycardia

    4. Aberrant conduction during atrial fibrillation

    Answer

    Case resolution

    The ECG shows a wide QRS complex tachycardia with irregular RR intervals, delta waves and no P waves, findings suggestive of Wolff-Parkinson-White syndrome with pre-excited …

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    Footnotes

    • Contributors CCO was responsible for the acute treatment of the patient as well as for the writing. SR and SM were responsible for the electrophysiologic study and the catheter ablation of the patient accessory pathway as well as for the supervision of this work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.