Wide complex tachycardia – diagnostic and therapeutic challenges
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http://orcid.org/0000-0003-1495-5062
Radu Andy Sascău
Mihaela Grecu
Grigore Tinică
Cătălina Arsenescu Georgescu
Cristian Stătescu
Abstract
Dilated cardiomyopathy is associated with ventricular arrhythmias and with an increased risk of sudden cardiac death. In these cases, wide complex tachyarrhythmias are frequently a diagnostic challenge. The efficiency of antiarrhythmic drug therapy is limited and often the implantation of a cardiac defibrillator is required. We hereby present the case of a 68 year old male patient known with dilated cardiomyopathy, who experienced a syncopal episode as the clinical expression of a wide complex tachycardia. The recorded electrocardiogram identified ventricular tachycardia originated in the right ventricle or in the interventricular septum. The electrocardiograms recorded before and after the syncopal episode showed a major left bundle-branch block and a first degree atrioventricular block. 24-hour Holter ECG monitoring detected ventricular tachycardia originating in the left ventricle. The etiology of the dilated cardiomyopathy, arrhythmias and conduction abnormalities could not be identified. During the electrophysiological study, no sustained supraventricular or ventricular tachyarrhythmias were triggered. The pharmacological treatment has been optimized and a cardiac defibrillator was implanted. The particularity of this case consists in the presence of multiple rhythm disturbances originating both in the left and right ventricle, in a patient with idiopathic dilated cardiomyopathy and conduction disturbances at several levels.
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idiopathic dilated cardiomyopathy, wide complex tachycardia
2. Poll D, Marchlinski F, Buxton A, Doherty J, Waxman H, Josephson M. Sustained ventricular tachycardia in patients with idiopathic dilated cardiomyopathy: electrophysiologic testing and lack of response to antiarrhythmic drug therapy. Circulation 1984; 70(3):451-456.
3. Olgin J, Zipes D. Specific Arrhythmias: Diagnosis and Treatment. In Braunwald's Heart Disease - A Textbook of Cardiovascular Medicine, 10th Edition. Philadelphia: Elsevier/Saunders. 2015; 776-780.
4. Burns E: Ventricular tachycardia - Life in the Fast lane ECG Library [http://lifeinthefastlane.com/ecg-library/ventricular-tachycardia/ available at 29.01.2017].
5. Burns E: Trifascicular Block - Life in the Fastlane ECG Library. [http://lifeinthefastlane.com/ecg-library/trifascicular-block/ available at 29.01.2017].
6. Priori S, Blomström-Lundqvist C, Mazzanti A, et al.; 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC). Eur Heart J 2015; 36 (41): 2804.
7. Tabatabaei P, Keikhavani A, Haghjoo M et al. Assessment of QT and JT intervals in patients with left bundle branch block. Res Cardiovasc Med 2016; 5(2): e31528.
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