Key result
ECG analysis reveals perpetuated Ashman aberrancy mimicking NSVT during wide-complex tachycardia in AF.
Why the study?
Differentiating perpetuated aberrant conduction from ventricular tachycardia in AF is challenging and may lead to inappropriate therapies.
Case Report (n=1)
Long runs of wide QRS complexes in atrial fibrillation may reflect perpetuated Ashman-type aberrancy rather than ventricular tachycardia, requiring accurate recognition to avoid inappropriate therapies.
May aid wide complex tachycardia diagnosis; leaves open need for larger trials before practice change.
BACKGROUND: Differentiating perpetuated aberrant conduction from ventricular tachycardia in atrial fibrillation (AF) is challenging and may lead to inappropriate therapies. CASE SUMMARY: A 64-year-old man with ischemic cardiomyopathy and AF presented with decompensated heart failure. Admission electrocardiogram showed a wide-complex tachycardia with runs of up to 10 consecutive aberrant QRS complexes mimicking nonsustained ventricular tachycardia (VT). Careful analysis revealed perpetuated Ashman-type aberrancy best explained by concealed transseptal conduction. Abrupt normalization despite a subsequent long-short sequence most likely reflected transient resolution of functional right bundle branch fatigue. DISCUSSION: This case demonstrates an unusually long run of perpetuated Ashman-type aberrancy in AF, a rare diagnostic challenge that mimics nonsustained VT and carries risk of inappropriate treatment. TAKE-HOME MESSAGES: Long runs of wide QRS complexes in AF may reflect perpetuated aberrancy rather than VT. Accurate recognition of this phenomenon is essential to avoid unnecessary and potentially harmful therapies.
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Roig et al. (2026) conducted a case report in Ischemic cardiomyopathy and atrial fibrillation with wide-complex tachycardia (n=1). Careful electrocardiogram analysis of a wide-complex tachycardia in a patient with atrial fibrillation revealed perpetuated Ashman-type aberrancy mimicking nonsustained ventricular tachycardia.
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