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Challenges in Clinical Electrocardiography |

Wide Complex Tachycardia and Adenosine

Joseph L. Schuller, MD1,2; Paul D. Varosy, MD1,3; Duy Thai Nguyen, MD1
[+] Author Affiliations
1Department of Medicine, University of Colorado, Aurora
2Denver Health Medical Center, Denver, Colorado
3VA Eastern Colorado Health Care System, University of Colorado, Colorado Cardiovascular Outcomes Research (CCOR) Group, Denver
JAMA Intern Med. 2013;173(17):1644-1646. doi:10.1001/jamainternmed.2013.8513.
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Extract

A 46-year-old African American woman with a history of palpitations presented to the emergency department with right chest discomfort and a racing pulse. A 12-lead electrocardiogram (ECG) was obtained (Figure 1). She had a recent echocardiogram showing a structurally normal heart.

Figure 1. Presenting Electrogram

Presenting electrocardiogram of a wide complex tachycardia with a right bundle branch block and left anterior fascicular block pattern. P waves are highlighted (arrows).

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Figure 1.
Presenting Electrogram

Presenting electrocardiogram of a wide complex tachycardia with a right bundle branch block and left anterior fascicular block pattern. P waves are highlighted (arrows).

Graphic Jump Location
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Figure 2.
Simultaneous Tracings of Leads I and V1 at the Time of Adenosine Administration

The initial portion of the electrocardiogram shows retrograde P waves (small arrows) in a 1:1 pattern with the QRS. After adenosine administration, there is ventriculoatrial dissociation, with loss of retrograde P waves (large arrows).

Graphic Jump Location

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