Key result
EP maneuvers and 3 mg adenosine unmask and terminate automatic AT in pre-excited tachycardia.
Case Report (n=1)
In a patient with pre-excitation, wide complex tachycardia can be caused by an atrial tachycardia with bystander accessory pathway conduction, which can be diagnosed via pacing maneuvers and terminated by small doses of adenosine.
Suggests atrial tachycardia with bystander conduction in pre-excited wide-complex tachycardia; hypothesis-generating for low-dose adenosine in electrophysiology.
Patients with Wolff-Parkinson-White syndrome are generally evaluated for symptomatic supraventricular tachycardia (SVT). Not infrequently, these patients are also at risk of wide complex tachycardia. Although overt pre-excitation in sinus rhythm is most often present in patients with Wolff-Parkinson-White syndrome, the absence of a delta wave on the resting electrocardiogram (ECG) does not preclude antegrade conduction over the accessory pathway. The deductive analysis required in the interpretation of wide complex tachycardia, and its termination by adenosine, in a patient with intermittent pre-excitation is reviewed.
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Yeo et al. (2017) conducted a case report in Wide complex tachycardia with intermittent pre-excitation (n=1). Electrophysiological testing and Adenosine was evaluated on Termination of tachycardia and diagnosis of mechanism. In a 29-year-old woman with pre-excitation, electrophysiological pacing maneuvers and administration of 3 mg of intravenous adenosine successfully diagnosed and terminated an automatic atrial tachycardia.
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