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Cardiology

An Interesting Wide QRS Complex Tachycardia

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JAMA Internal Medicine

Published Online: September 5, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Qinghua Chang, MD¹;

Gaopin Wang, MD¹;

Renguang Liu, MD¹

Author Affiliations

¹The Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China

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A patient in their 70s presented to the emergency department with sudden-onset tachycardia that had been going on for more than 1 day. The patient had been experiencing recurrent palpitations for the past 20 years. The presenting electrocardiogram (ECG) showed a regular wide QRS complex tachycardia at a rate of 148 beats per minute (Figure, A). Synchronized direct current cardioversion was administered, resulting in restoration of normal sinus rhythm. The ECG recorded after cardioversion showed that the QRS morphology was identical to that recorded during tachycardia (Figure, B).

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A patient in their 70s presented to the emergency department with sudden-onset tachycardia that had been going on for more than 1 day. The patient had been experiencing recurrent palpitations for the past 20 years. The presenting electrocardiogram (ECG) showed a regular wide QRS complex tachycardia at a rate of 148 beats per minute (Figure, A). Synchronized direct current cardioversion was administered, resulting in restoration of normal sinus rhythm. The ECG recorded after cardioversion showed that the QRS morphology was identical to that recorded during tachycardia (Figure, B).

Questions: What is the most likely diagnosis of the patient’s wide QRS complex tachycardia? What is the special clinical significance of the fact that the QRS morphology shown during sinus rhythm was identical to that recorded during tachycardia?

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Article Information

Corresponding Author: Renguang Liu, MD, The Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Renmin Street, Jinzhou 121000, Liaoning Province, China (liurenguanglaoshi@126.com).

Published Online: September 5, 2023. doi:10.1001/jamainternmed.2023.2270

Conflict of Interest Disclosures: None reported.

References

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Zhang Y , Liu R , Chen Y . Association of WPW syndrome and first-degree atrioventricular block: electrocardiographic diagnosis. Herz. 2014;39(7):834-836. doi:10.1007/s00059-013-3877-0 PubMed Google Scholar Crossref

Liu R , Chang Q . The diagnosis of myocardial infarction in the Wolff-Parkinson-White syndrome. Int J Cardiol. 2013;167(3):1083-1084. doi:10.1016/j.ijcard.2012.10.055 PubMed Google Scholar Crossref

Brugada J , Katritsis DG , Arbelo E , et al; ESC Scientific Document Group. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia: the task force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(5):655-720. doi:10.1093/eurheartj/ehz467 PubMed Google Scholar Crossref

Sharma E , Wu M . A man with incessant narrow complex tachycardia. JAMA. 2019;322(21):2127-2128. doi:10.1001/jama.2019.16560 PubMed Google Scholar Crossref

Wellens HJ . Sudden rate acceleration in a 41-year-old man with a wide QRS tachycardia. Heart Rhythm. 2020;17(6):1050-1051. doi:10.1016/j.hrthm.2020.01.023 PubMed Google Scholar Crossref

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