[Skip to Content]
[Skip to Content Landing]

Narrow Complex Tachycardia

To identify the key insights or developments described in this article
1 Credit CME

A patient in their 50s presented to the emergency department with sudden-onset, severe palpitations lasting for 2 hours. The patient experienced similar prior episodes that had terminated within minutes, either spontaneously or with deep breathing. On physical examination, the patient was in mild distress. Their blood pressure was 108/78 beats per minute (bpm) and their heart rate was 188 bpm. The 12-lead electrocardiogram (ECG) is shown in the Figure (A).

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

A patient in their 50s presented to the emergency department with sudden-onset, severe palpitations lasting for 2 hours. The patient experienced similar prior episodes that had terminated within minutes, either spontaneously or with deep breathing. On physical examination, the patient was in mild distress. Their blood pressure was 108/78 beats per minute (bpm) and their heart rate was 188 bpm. The 12-lead electrocardiogram (ECG) is shown in the Figure (A).

Questions: Is there enough information in this ECG to make a definitive diagnosis? If so, what is the diagnosis?

The ECG showed a narrow complex tachycardia at 188 bpm with retrograde P waves best seen in the lead II rhythm strip. The time from the QRS to the P wave is longer than that from the P wave to the QRS, making this a long RP tachycardia. The differential diagnosis of a regular, narrow complex, long RP tachycardia includes the atypical form of atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), and atrial tachycardia (AT).

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity
Our websites may be periodically unavailable between 7:00pm CT December 9, 2023 and 1:00am CT December 10, 2023 for regularly scheduled maintenance.

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Tharian S. Cherian, MD, 320 E North Ave, Pittsburgh, PA 15212 (tharian.cherian@ahn.org).

Published Online: August 7, 2023. doi:10.1001/jamainternmed.2023.2250

Conflict of Interest Disclosures: Dr Silverstein reported personal fees from Medtronic, Biosense Webster, Volta, and Impulse Dynamics outside the submitted work. No other disclosures were reported.

References
1.
Katritsis  DG , Josephson  ME .  Differential diagnosis of regular, narrow-QRS tachycardias.   Heart Rhythm. 2015;12(7):1667-1676. doi:10.1016/j.hrthm.2015.03.046PubMedGoogle ScholarCrossref
2.
Josephson  ME .  Clinical Cardiac Electrophysiology: Techniques and Interpretations. 5th ed. Wolters Kluwers Health; 2008.
3.
Katritsis  DG , Josephson  ME .  Classification, electrophysiological features and therapy of atrioventricular nodal reentrant tachycardia.   Arrhythm Electrophysiol Rev. 2016;5(2):130-135. doi:10.15420/AER.2016.18.2PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close