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....
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-11-01
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| Series: | Annals of Noninvasive Electrocardiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/anec.12836 |
| _version_ | 1818826754015363072 |
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| 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 |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-19T00:32:41Z |
| format | Article |
| id | doaj.art-4b091c5f54454929ba11f3956c4f2291 |
| institution | Directory Open Access Journal |
| issn | 1082-720X 1542-474X |
| language | English |
| last_indexed | 2024-12-19T00:32:41Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Noninvasive Electrocardiology |
| spelling | doaj.art-4b091c5f54454929ba11f3956c4f22912022-12-21T20:45:00ZengWileyAnnals of Noninvasive Electrocardiology1082-720X1542-474X2021-11-01266n/an/a10.1111/anec.12836Alternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?Songwen Chen0Feilong Zhang1Yong Wei2Xiaofeng Lu3Genqing Zhou4Shaowen Liu5Department of Cardiology Shanghai General Hospital Shanghai Jiao Tong UniversitySchool of Medicine Shangai ChinaDepartment of Cardiology Fujian Medical University Union Hospital Fuzhou ChinaDepartment of Cardiology Shanghai General Hospital Shanghai Jiao Tong UniversitySchool of Medicine Shangai ChinaDepartment of Cardiology Shanghai General Hospital Shanghai Jiao Tong UniversitySchool of Medicine Shangai ChinaDepartment of Cardiology Shanghai General Hospital Shanghai Jiao Tong UniversitySchool of Medicine Shangai ChinaDepartment of Cardiology Shanghai General Hospital Shanghai Jiao Tong UniversitySchool of Medicine Shangai ChinaAbstract 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.https://doi.org/10.1111/anec.12836alternating QRSventricular tachycardia |
| spellingShingle | 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? Annals of Noninvasive Electrocardiology alternating QRS ventricular tachycardia |
| title | 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_short | 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 |
| topic | alternating QRS ventricular tachycardia |
| url | https://doi.org/10.1111/anec.12836 |
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