Atrial Arrhythmias

Case 20 Answer

Supraventricular Tachycardia 1

History:
This ECG was recorded from a 78 year-old man with a history of chronic bronchiectasis, he presented with an acute onset of SOB.

ECG shows:

  • Wide complex tachycardia, 170/min
        -regular ventricular rhythm
        -p waves hidden in T waves of lead V1 and V4 (arrow)
  • DDx for Wide QRS regular tachycardia:
        -VT
        -SVT with bundle branch block
        -SVT with phasic aberrant ventricular conduction
        -WPW syndrome
  • RAD, RBBB, QT interval for rate
  • Severe RVH (prominent R wave in V1-4)
  • PVC
  • This suggests a diagnosis of SVT with preexisiting RBBB
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