What is the clinical evidence from this study?

Study design: Case Report. Population: Wide complex tachycardia (n=1). Intervention: Electrophysiology study and radiofrequency ablation. Primary outcome: Recurrence of arrhythmia.

What does this research mean for the field?

ECG-based algorithms have significant limitations in distinguishing ventricular tachycardia from supraventricular tachycardia with aberrancy, particularly when confounded by technical errors such as lead misplacement, necessitating invasive electrophysiology studies for definitive diagnosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To establish the definitive electrophysiological mechanism of recurrent wide complex tachycardia in a patient with conflicting electrocardiographic tracings and suspected limb lead misplacement.

May 24, 2026CureusOpen Access

An Endless Riddle of Wide Complex Tachycardia: Ventricular Tachycardia (VT) or Supraventricular Tachycardia (SVT)?

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Key result

EP study and slow pathway ablation successfully treat typical AVNRT presenting as wide complex tachycardia.

Why the study?

Wide complex tachycardia presents a diagnostic challenge, particularly in distinguishing ventricular tachycardia from supraventricular tachycardia with aberrancy.

Key Points

To establish the definitive electrophysiological mechanism of recurrent wide complex tachycardia in a patient with conflicting electrocardiographic tracings and suspected limb lead misplacement.
Evaluated an 81-year-old man with previous myocardial infarction presenting with recurrent wide complex tachycardia and discordant limb lead polarities on serial electrocardiograms.
Performed an invasive electrophysiology study utilizing atrial double extrastimulus testing, parahisian pacing, and ventricular overdrive pacing to map conduction.
Delivered radiofrequency catheter ablation targeting the right inferior extension of the slow pathway.
Electrophysiology testing induced a wide complex tachycardia with a cycle length of 375 ms and simultaneous atrioventricular activation (VA = 0), confirming typical atrioventricular nodal reentrant tachycardia with aberrant conduction.
Radiofrequency ablation targeting the slow pathway across nine applications totaling 8.2 minutes eliminated the atrio-His jump and rendered the arrhythmia noninducible.
The patient experienced complete freedom from recurrent wide complex tachycardia during five months of follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

81-year-old man with recurrent wide complex tachycardia (WCT), prior myocardial infarction, preserved left ventricular ejection fraction, diabetes mellitus, chronic kidney disease, and hypertension.

Intervention

Electrophysiology (EP) study and slow pathway radiofrequency ablation

Outcome

Diagnosis of underlying arrhythmia mechanism and freedom from recurrent arrhythmia

This case highlights the limitations of ECG-based algorithms for wide complex tachycardia and the importance of recognizing limb lead misplacement and utilizing invasive EP studies for definitive diagnosis.

Limitations

Inherent limitations and potential biases associated with a single-patient case report
Recognition of the limb lead reversal was made retrospectively rather than during the patient's initial presentation
Currently available follow-up data remain limited to the short term
single-patient case report
recognition of the limb lead reversal was made retrospectively
follow-up data remain limited to the short term

Implication

May support EP study when ECG is inconclusive in elderly wide complex tachycardia; leaves open generalizability beyond this single case.

Abstract

Wide complex tachycardia (WCT) presents a diagnostic challenge, particularly in distinguishing ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrancy. We report an 81-year-old man with recurrent WCT initially suspected to be VT based on clinical and electrocardiographic features. However, inconsistencies across serial electrocardiographic tracings limited diagnostic certainty. Specifically, variations in polarity across all limb leads, except aVR and the precordial leads, raised suspicion for limb lead misplacement, particularly left arm-left leg reversal. This electrocardiographic perplexity further complicated the clinical interpretation. To clarify the underlying arrhythmia mechanism, an electrophysiology (EP) study was performed, which demonstrated inducible tachycardia with simultaneous atrioventricular activation (VA = 0), consistent with typical atrioventricular nodal reentrant tachycardia (AVNRT) with aberrancy. Successful slow pathway ablation rendered the arrhythmia noninducible, and the patient has remained free of recurrent arrhythmia during five months of follow-up. This case highlights the limitations of ECG-based algorithms and the importance of careful ECG interpretation and invasive evaluation.

Discussion

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Published by Cureus · CC BY

Cite This Study

Prasitlumkum et al. (2026) conducted a case report in Wide complex tachycardia (n=1). Electrophysiology study and radiofrequency ablation was evaluated on Recurrence of arrhythmia. Electrophysiology study and slow pathway ablation successfully diagnosed and treated typical atrioventricular nodal reentrant tachycardia with aberrancy in an 81-year-old man presenting with wide complex tachycardia.

synapsesocial.com/papers/6a1296c748a0ea1665673da4 https://doi.org/10.7759/cureus.109414

Topics

Ventricular arrhythmias

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Implication

May support EP study when ECG is inconclusive in elderly wide complex tachycardia; leaves open generalizability beyond this single case.

An Endless Riddle of Wide Complex Tachycardia: Ventricular Tachycardia (VT) or Supraventricular Tachycardia (SVT)?

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

An Endless Riddle of Wide Complex Tachycardia: Ventricular Tachycardia (VT) or Supraventricular Tachycardia (SVT)?

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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