open access

Vol 10, No 2 (2015)
Case Reports
Published online: 2015-05-22
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Rhythm with wide QRS — diffi culty in interpreting

Grzegorz Karkowski, Marcin Kuniewicz, Andrzej Ząbek, Jacek Bednarek, Jacek Lelakowski
DOI: 10.5603/FC.2015.0020
·
Folia Cardiologica 2015;10(2):122-126.

open access

Vol 10, No 2 (2015)
Case Reports
Published online: 2015-05-22

Abstract

In the case described we demonstrate the difficulty in interpreting the rhythm with wide QRS complex. The 25 year old patient with ventricular pre-excitation and periodically occurring rhythm with wide QRS complex, morphology meets the electrocardiographic (ECG) criteria for ventricular arrhythmias and in the absence of P waves. Initial difficulties in the interpretation of ECG were explained by electrophysiological study in which we demonstrate the supraventricular origin of rhythm conducted to the ventricles with pre-excitation. Radio frequency ablation of the accessory pathway reveals the periodically occurring low-atrial rhythm originating in the muscle of the coronary sinus. Very close proximity of the atrial rhythm and the accessory pathway resulted instant conduction of impulse to the ventricle and cause perfect imitation of ventricular rhythm. This case draws attention on the need to take account of none-sinus rhythm with ventricular preexcitation during diagnosis of rhythm with wide QRS complex.

Abstract

In the case described we demonstrate the difficulty in interpreting the rhythm with wide QRS complex. The 25 year old patient with ventricular pre-excitation and periodically occurring rhythm with wide QRS complex, morphology meets the electrocardiographic (ECG) criteria for ventricular arrhythmias and in the absence of P waves. Initial difficulties in the interpretation of ECG were explained by electrophysiological study in which we demonstrate the supraventricular origin of rhythm conducted to the ventricles with pre-excitation. Radio frequency ablation of the accessory pathway reveals the periodically occurring low-atrial rhythm originating in the muscle of the coronary sinus. Very close proximity of the atrial rhythm and the accessory pathway resulted instant conduction of impulse to the ventricle and cause perfect imitation of ventricular rhythm. This case draws attention on the need to take account of none-sinus rhythm with ventricular preexcitation during diagnosis of rhythm with wide QRS complex.

Get Citation

Keywords

pre-excitation, ablation, broad QRS complex rhythm

About this article
Title

Rhythm with wide QRS — diffi culty in interpreting

Journal

Folia Cardiologica

Issue

Vol 10, No 2 (2015)

Pages

122-126

Published online

2015-05-22

DOI

10.5603/FC.2015.0020

Bibliographic record

Folia Cardiologica 2015;10(2):122-126.

Keywords

pre-excitation
ablation
broad QRS complex rhythm

Authors

Grzegorz Karkowski
Marcin Kuniewicz
Andrzej Ząbek
Jacek Bednarek
Jacek Lelakowski

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