Challenges in Clinical Electrocardiography |

Wide-Complex Tachycardia in a Patient With Coronary Disease—Diagnosis

JAMA Intern Med. 2013;173(11):951-952. doi:10.1001/jamainternmed.2013.109b.
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Correspondence: Jordan M. Prutkin, MD, MHS, Division of Cardiology, Section of Cardiac Electrophysiology, University of Washington, 1959 Pacific St NE, PO Box 356422, Seattle, WA 98195 (jprutkin@cardiology.washington.edu).

Published Online: April 1, 2013. doi:10.1001/jamainternmed.2013.109

Conflict of Interest Disclosures: None reported.

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Graphic Jump Location

Figure 3. A 12-lead electrocardiogram during left atrial pacing in the coronary sinus. The pacing stimulus artifact (stim) is marked with an arrow. A delta wave is noted (arrow), with QRS morphology identical to those of the clinical tachycardia. In sinus rhythm, since the sinus node is anatomically closer to the atrioventricular (AV) node than to the left-sided accessory pathway, conduction proceeds preferentially over the normal conduction system, and preexcitation is not demonstrated. By pacing the left atrium, anatomically closer to the accessory pathway than to the AV node, conduction occurs preferentially over the accessory pathway and the delta wave becomes apparent. Calipers denote the onset of the P wave, QRS complex, and T wave; ms indicates milliseconds.

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Graphic Jump Location

Figure 4. Cartoon illustration of anterograde conduction during sinus rhythm in the presence of an accessory pathway (AP). The sinus node in the right atrium (RA) is anatomically closer to the atrioventricular node than an AP connection between the left atrium (LA) and left ventricle (LV). The right ventricle (RV) is also depicted.




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