|
|
|
Clin. Cardiol. 23, 63–65 (2000)
Nikolaos Dagres, M.D., Jonathan R. Clague, M.D., MRCP, Hans Kottkamp, M.D., Günter Breithardt, M.D., FESC, FACC, Martin Borggrefe, M.D., FESC
Department of Cardiology and Angiology, Westfälische Wilhelms-University, Münster, Germany
Summary: The differentiation between ventricular tachycardia and broad-complex supraventricular tachycardia can be extremely difficult, particularly in emergency situations. We report a case of hemodynamically compromising broad-complex tachycardia in a 63-year-old man. The patient had previously sustained an anteroseptal myocardial infarction and had subsequently undergone coronary artery bypass surgery because of triple-vessel coronary artery disease. Intravenous treatment with ajmalin terminated the tachycardia and revealed preexcited QRS complexes compatible with the presence of a left-sided atrioventricular accessory pathway. An antidromic atrioventricular reentrant tachycardia (identical to the clinical tachycardia) was induced during an electrophysiologic study. In conclusion, there are several causes of broad-complex tachycardia, even in patients with previous myocardial infarction, and, where doubt exists, electrophysiologic studies should be performed.
Key words: Wolff-Parkinson-White syndrome, antidromic atrioventricular reentrant tachycardia, ventricular tachycardia, coronary artery disease, myocardial infarction
Present affiliations:
Dr. Dagres: Department of Cardiology, University of Essen, Germany
Dr. Clague: Royal Brompton Hospital, London, United Kingdom
Dr. Kottkamp: University Leipzig-Heart Center, Germany
Address for reprints:
Dr. Nikolaos Dagres
Abteilung fuer Kardiologie
Medizinische Klinik
Universitaetsklinikum Essen
Hufelandstr. 55
45122 Essen, Germany
Received: November 18, 1998
Accepted with revision: February 19, 1999