Alternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?

Abstract A 23‐year‐old woman with palpitations for 9 years was referred for catheter ablation. ECG showed an irregular narrow complex tachycardia with alternating and gradually changing QRS morphologies after alternating and changing RR intervals, with a clear pattern of 2 alternating QRS complexes....

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Songwen Chen, Feilong Zhang, Yong Wei, Xiaofeng Lu, Genqing Zhou, Shaowen Liu
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	alternating QRS ventricular tachycardia Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/4b091c5f54454929ba11f3956c4f2291
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:4b091c5f54454929ba11f3956c4f2291
record_format	dspace
spelling	oai:doaj.org-article:4b091c5f54454929ba11f3956c4f22912021-11-12T11:40:14ZAlternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?1542-474X1082-720X10.1111/anec.12836https://doaj.org/article/4b091c5f54454929ba11f3956c4f22912021-11-01T00:00:00Zhttps://doi.org/10.1111/anec.12836https://doaj.org/toc/1082-720Xhttps://doaj.org/toc/1542-474XAbstract A 23‐year‐old woman with palpitations for 9 years was referred for catheter ablation. ECG showed an irregular narrow complex tachycardia with alternating and gradually changing QRS morphologies after alternating and changing RR intervals, with a clear pattern of 2 alternating QRS complexes. An electrophysiology study was performed and confirmed that the mechanism of tachycardia was an automatic left‐side His‐Purkinje system (HPS) ventricular tachycardia. The gradually changing type‐2 QRS complexes was the conduction delayed in the left anterior fascicle due to the short RR interval or the short left‐side HH interval. Nine months after the index electrophysiology study, the patient encounter a progressive of heart failure with increased heart rate to 130‐150 bpm during rest. Radiofrequency ablation was performed at the upper‐septum for eliminating the tachycardia and resulted in complete atrioventricular block. A permanent pacemaker with left bundle branch pacing was implanted. Twelve months after the ablation, the enlarged heart shrink to normal with normal left ventricular ejection fraction. In conclusion, careful interpretation of the ECG can identify the sinus P waves followed by irregular narrow complexes, thus avoiding misdiagnosis and unnecessary treatment. Unifocal HPS tachycardia could present with alternating and gradually changing narrow QRS complexes tachycardia and lead to tachycardia cardiomyopathy. Electrophysiology study and catheter ablation were useful for the diagnosis and treatment of HPS tachycardia but with high risk of atrioventricular block. However, successfully elimination the tachycardia would resolve and reverse the enlarged heart and deteriorative heart function.Songwen ChenFeilong ZhangYong WeiXiaofeng LuGenqing ZhouShaowen LiuWileyarticlealternating QRSventricular tachycardiaDiseases of the circulatory (Cardiovascular) systemRC666-701ENAnnals of Noninvasive Electrocardiology, Vol 26, Iss 6, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	alternating QRS ventricular tachycardia Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	alternating QRS ventricular tachycardia Diseases of the circulatory (Cardiovascular) system RC666-701 Songwen Chen Feilong Zhang Yong Wei Xiaofeng Lu Genqing Zhou Shaowen Liu Alternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?
description	Abstract A 23‐year‐old woman with palpitations for 9 years was referred for catheter ablation. ECG showed an irregular narrow complex tachycardia with alternating and gradually changing QRS morphologies after alternating and changing RR intervals, with a clear pattern of 2 alternating QRS complexes. An electrophysiology study was performed and confirmed that the mechanism of tachycardia was an automatic left‐side His‐Purkinje system (HPS) ventricular tachycardia. The gradually changing type‐2 QRS complexes was the conduction delayed in the left anterior fascicle due to the short RR interval or the short left‐side HH interval. Nine months after the index electrophysiology study, the patient encounter a progressive of heart failure with increased heart rate to 130‐150 bpm during rest. Radiofrequency ablation was performed at the upper‐septum for eliminating the tachycardia and resulted in complete atrioventricular block. A permanent pacemaker with left bundle branch pacing was implanted. Twelve months after the ablation, the enlarged heart shrink to normal with normal left ventricular ejection fraction. In conclusion, careful interpretation of the ECG can identify the sinus P waves followed by irregular narrow complexes, thus avoiding misdiagnosis and unnecessary treatment. Unifocal HPS tachycardia could present with alternating and gradually changing narrow QRS complexes tachycardia and lead to tachycardia cardiomyopathy. Electrophysiology study and catheter ablation were useful for the diagnosis and treatment of HPS tachycardia but with high risk of atrioventricular block. However, successfully elimination the tachycardia would resolve and reverse the enlarged heart and deteriorative heart function.
format	article
author	Songwen Chen Feilong Zhang Yong Wei Xiaofeng Lu Genqing Zhou Shaowen Liu
author_facet	Songwen Chen Feilong Zhang Yong Wei Xiaofeng Lu Genqing Zhou Shaowen Liu
author_sort	Songwen Chen
title	Alternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?
title_short	Alternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?
title_full	Alternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?
title_fullStr	Alternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?
title_full_unstemmed	Alternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?
title_sort	alternating and gradually changing narrow qrs complex tachycardia in a patient with heart failure: what is the mechanism?
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/4b091c5f54454929ba11f3956c4f2291
work_keys_str_mv	AT songwenchen alternatingandgraduallychangingnarrowqrscomplextachycardiainapatientwithheartfailurewhatisthemechanism AT feilongzhang alternatingandgraduallychangingnarrowqrscomplextachycardiainapatientwithheartfailurewhatisthemechanism AT yongwei alternatingandgraduallychangingnarrowqrscomplextachycardiainapatientwithheartfailurewhatisthemechanism AT xiaofenglu alternatingandgraduallychangingnarrowqrscomplextachycardiainapatientwithheartfailurewhatisthemechanism AT genqingzhou alternatingandgraduallychangingnarrowqrscomplextachycardiainapatientwithheartfailurewhatisthemechanism AT shaowenliu alternatingandgraduallychangingnarrowqrscomplextachycardiainapatientwithheartfailurewhatisthemechanism
_version_	1718430614803185664

Alternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?

Ejemplares similares