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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.
What is the most probable diagnosis?
Pre-excited atrial fibrillation
Antidromic atrioventricular re-entrant tachycardia
Aberrant conduction during atrial fibrillation
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 …
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.