Wide QRS Tachycardia in WPW: When Antidromic AVRT Imitates VT

Atrioventricular Re‐entry Tachycardia (AVRT) occurs in patients with accessory pathways (AP) via a re‐entry circuit between the AV node and the AP. Anterograde conduction through the AP causes antidromic AVRT with wide QRS complexes, which may mimic ventricular tachycardia (VT). We report a 59‐year‐old male with ischemic cardiomyopathy (EF 35%) and recurrent wide QRS tachycardia who was referred for ICD implantation. Electrophysiology study identified a left posterolateral AP, and radiofrequency ablation successfully eliminated pre‐excitation. ICD implantation was subsequently performed without complications. Antidromic AVRT should be considered in the differential diagnosis of wide QRS tachycardia, and catheter ablation remains a safe and effective treatment.