Article Text

Download PDFPDF
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}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

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.


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


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 …

View Full Text


  • 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.