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Cardiology

“Narrow-Wide-Narrow” QRS Complex Tachycardia—Beware the Smartwatch Monsters

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JAMA Internal Medicine

Published Online: May 15, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Vincenzo Russo, MD, PhD¹;

Antonia Ascrizzi, MD¹;

Alfredo Mauriello, MD¹

Author Affiliations

¹Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy

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A young adult patient was referred to our Arrhythmic Unit for palpitations associated with chest pain and lightheadedness. The patient's anamnesis revealed no previous arrhythmic episodes or family history of sudden cardiac death. The physical examination results were unremarkable. The results of laboratory tests, a 12-lead electrocardiogram (ECG), and transthoracic echocardiography were normal. The patient’s smartwatch (Apple Watch Series 5, watchOS 6.2.8; Apple Inc) recorded a narrow QRS regular tachycardia triggering a nonsustained phase of wide complex irregular tachycardia; finally, the tachycardia again assumes a wide complex configuration until spontaneous termination occurs some beats later (Figure).

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A young adult patient was referred to our Arrhythmic Unit for palpitations associated with chest pain and lightheadedness. The patient's anamnesis revealed no previous arrhythmic episodes or family history of sudden cardiac death. The physical examination results were unremarkable. The results of laboratory tests, a 12-lead electrocardiogram (ECG), and transthoracic echocardiography were normal. The patient’s smartwatch (Apple Watch Series 5, watchOS 6.2.8; Apple Inc) recorded a narrow QRS regular tachycardia triggering a nonsustained phase of wide complex irregular tachycardia; finally, the tachycardia again assumes a wide complex configuration until spontaneous termination occurs some beats later (Figure).

Questions: What is the most likely diagnosis? What are the next steps in managing this patient?

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Article Information

Corresponding Author: Vincenzo Russo, MD, PhD, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Via Leonardo Bianchi, 80136 Naples, Italy (vincenzo.russo@unicampania.it).

Published Online: May 15, 2023. doi:10.1001/jamainternmed.2023.0683

Conflict of Interest Disclosures: None reported.

References

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Burke J , Haigney MCP , Borne R , Krantz MJ . Smartwatch detection of ventricular tachycardia: Case series. HeartRhythm Case Rep. 2020;6(10):800-804. doi:10.1016/j.hrcr.2020.08.003 PubMed Google Scholar Crossref

Cobos Gil MA , Unzueta-Roch JL . Artifacts in the electrocardiograms recorded using a smartwatch. Turk Kardiyol Dern Ars. 2022;50(7):540-541. doi:10.5543/tkda.2022.22472 PubMed Google Scholar Crossref

Wylie JV Jr , Milliez P , Germano JJ , et al. Atrioventricular nodal reentrant tachycardia associated with idiopathic ventricular tachycardia: clinical and electrophysiologic characteristics. J Electrocardiol. 2007;40(1):94-99. doi:10.1016/j.jelectrocard.2006.04.004 PubMed Google Scholar Crossref

de Vries L , Hendriks A , Szili-Torok T . The “dead-end tract” and its role in arrhythmogenesis. J Cardiovasc Dev Dis. 2016;3(2):11. doi:10.3390/jcdd3020011 PubMed Google Scholar Crossref

Oomen AWGJ , van Huysduynen BH , Sy RW . Supraventricular tachycardia triggering polymorphic ventricular tachycardia. HeartRhythm Case Rep. 2019;5(10):505-510. doi:10.1016/j.hrcr.2019.07.005 PubMed Google Scholar Crossref

Carbone V , Poggi A , Marafioti V , Oreto G . “Wide-narrow-wide” QRS complex tachycardia: what is the mechanism? Heart Rhythm. 2016;13(10):2095-2097. doi:10.1016/j.hrthm.2016.06.011 PubMed Google Scholar Crossref

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