title: Adenosine-sensitive wide-complex tachycardia: an uncommon variant of idiopathic fascicular ventricular tachycardia--a case report.
abstract: Most wide-complex tachycardias encountered in the emergency department (ED) are ventricular in origin, most commonly associated with structural heart disease. Ventricular tachyarrhythmias range in severity from life-threatening rhythms (eg, ventricular fibrillation and hemodynamically compromising ventricular tachycardia [VT]) to idiopathic forms of VT, which have a benign clinical course and a more favorable prognosis. The authors present the case of a 34-year-old woman who presented to the ED, with a wide-complex tachycardia with a right-bundle-branch block (RBBB) morphology and a right inferior axis, which was terminated with adenosine. The patient was previously misdiagnosed as suffering from a paroxysmal supraventricular tachycardia (SVT), which was unresponsive to beta-blocker therapy. Although the tachycardia responded to adenosine, suggestive of an SVT, the patient was referred to the arrhythmia service, where further work-up revealed an uncommon form of an idiopathic VT, originating from the left anterior fascicle. The authors discuss the unique electrocardiographic and electrophysiologic properties and useful diagnostic maneuvers required to properly identify this form of VT.
authors.affiliation: Clinical Electrophysiologic Services, Division of Cardiology, Department of Medicine, New York Methodist Hospital, Brooklyn, NY 11215, USA. JTK747@aol.com
authors.forename: John
authors.initials: J
authors.lastname: Kassotis
authors.forename: Todd
authors.initials: T
authors.lastname: Slesinger
authors.forename: Emir
authors.initials: E
authors.lastname: Festic
authors.forename: Louis
authors.initials: L
authors.lastname: Voigt
authors.forename: C V R
authors.initials: CV
authors.lastname: Reddy
mesh_terms: D000241:Adenosine / Q000627:therapeutic use; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000188:drug therapy; D014700:Verapamil / Q000627:therapeutic use
chemical_list: D000889:Anti-Arrhythmia Agents; D014700:Verapamil; D000241:Adenosine