A 35-year-old female comes to JIPMER Pondicherry, India, an emergency department with the history of acute onset palpitation since last one hours not associated with giddiness, syncope or vomiting. History of similar episode on and off since last 2 years, acute in onset, remain for one or two hours subsided after hospitalization, occur once every two weeks. During evaluation patient pulse rate was 210 beats per minute, BP-110/70 mmHg, ECHO heart was normal. Tachycardia of patient was subsided after giving injection adenosine in the emergency department.
ECG during tachycardia
Description of the ECG Narrow complex regular tachycardia at rate of 210 beats per minute, Normal axis, T wave inversion seen in lead II,III,aVF, V3-V6. ??Pseudo R wave seen in lead V1, (Although i am not sure )So this patient is having short RP tachycardia with RP interval nearly 40 msec so the differential most likely is AVNRT, other possibility could be ANRT due to orthodromic tachycarida
ECG during tachycardia
ECG during tachycardia
ECG after giving injection adenosine
Normal sinus rhythm at 90 per minute, left axis deviation, PR interval 80 msec, delta wave are seen, Negative delta wave seen in lead V1, II,III,aVF, Positive delta wave seen in lead I, aVL, V2-V6, Secondary ST-segment depression with T wave inversion seen in lead I, aVL, V2-V6
ECG after giving injection adenosine
So this patient is a case of PSVT with baseline ecg suggestive of preexcitation so the final diagnosis of this patient is WPW syndrome with Short RP tachycardia most likely AVNRT or AVRT
Approach in a patient with WPW syndrome for pathway localisation
Patient underwent Electrophysiological study at JIPMER, Pondicherry, India by Dr Raja Selvaraj and his team and found to have orthodromic AVRT. Patient underwent successful radiofrequency ablation.
Approach in a patient with Short RP tachycardia
Thank you
Praveen Gupta
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