Antidromic atrioventricular reentrant tachycardia mimicking ventricular tachycardia in the setting of previous myocardial infarction.
The differentiation between ventricular tachycardia and broad-complex supraventricular tachycardia can be extremely difficult, particularly in emergency situations. We report a case of hemodynamically compromising broad-complex tachycardia in a 63-year-old man. The patient had previously sustained an anteroseptal myocardial infarction and had subsequently undergone coronary artery bypass surgery because of triple-vessel coronary artery disease. Intravenous treatment with ajmalin terminated the tachycardia and revealed preexcited QRS complexes compatible with the presence of a left-sided atrioventricular accessory pathway. An antidromic atrioventricular reentrant tachycardia (identical to the clinical tachycardia) was induced during an electrophysiologic study. In conclusion, there are several causes of broad-complex tachycardia, even in patients with previous myocardial infarction, and, where doubt exists, electrophysiologic studies should be performed.
Dagres
N
N
Department of Cardiology and Angiology, Westfálische Wilhelms-University, Münster, Germany.
Clague
J R
JR
Kottkamp
H
H
Breithardt
G
G
Borggrefe
M
M
D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis* / Q000209:etiology; D017180:Tachycardia, Ventricular / Q000175:diagnosis; D017211:Treatment Failure; D014927:Wolff-Parkinson-White Syndrome / Q000175:diagnosis