Key result
TEE Doppler clarifies atrial mechanical activity and tachycardia mechanism in diagnostically uncertain WCT.
Case Report (n=1)
In cases of wide complex tachycardia with diagnostic uncertainty, echocardiographic Doppler can provide meaningful insight into atrial mechanical activity and the tachycardia mechanism.
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May inform mechanism assessment in uncertain wide complex tachycardia; leaves open whether it changes management or outcomes.
CASE SUMMARY: A 72-year-old woman presented with dyspnea and unstable wide complex tachycardia (WCT). Initial cardioversion was unsuccessful. Amiodarone was started, and she briefly converted to sinus bradycardia. WCT recurred 2 days later. Coronary angiography performed for non-ST-segment elevation myocardial infarction demonstrated patent bypass grafts with no new obstructive lesions. She subsequently suffered a stroke, raising concern for atrial flutter and left atrial appendage (LAA) thrombus, prohibiting further use of amiodarone. A rate control strategy was limited because of hypotension and renal dysfunction. Transesophageal echocardiogram performed for stroke evaluation revealed an LAA Doppler pattern inconsistent with flutter and no LAA thrombus. Amiodarone was resumed. TAKE-HOME MESSAGE: In cases of WCT with diagnostic uncertainty, echocardiographic Doppler can provide meaningful insight into atrial mechanical activity and thus the tachycardia mechanism.
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Khattab et al. (2026) conducted a case report in Wide complex tachycardia (n=1). Echocardiographic Doppler was evaluated. Echocardiographic Doppler provided meaningful insight into atrial mechanical activity and the tachycardia mechanism in a patient with wide complex tachycardia of diagnostic uncertainty.
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