Key result
Stepwise vagal maneuvers, adenosine, verapamil, and cardioversion fail to terminate incessant wide complex tachycardia.
Case Report (n=1)
A case report highlighting an incessant wide complex tachycardia in a young male that was refractory to standard medical and electrical cardioversion.
Standard stepwise management may fail in incessant wide complex tachycardia; leaves open need for alternative strategies in refractory cases.
ECG CHALLENGEA 26-year-old male with no past medical issues presented with 24-hour sudden onset palpitations, chest discomfort, and dizziness.He was hemodynamically stable and his heart rate was 189 bpm, with no other remarkable findings on physical examination.A 12-lead ECG (Figure 1) showed regular wide complex tachycardia with right bundle-branch block and extreme superior axis.Stepwise management was provided with vagal maneuvers, escalating doses of adenosine, uptitrated intravenous verapamil, and cardioversion with serial discharges ≤270 J of biphasic energy.However, all interventions were ineffective, and the tachycardia remained incessant.What is the arrhythmia, and what cardiac structure is involved in its origin?Please turn the page to read the diagnosis.
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Miranda‐Arboleda et al. (2018) conducted a case report in Wide complex tachycardia (n=1). Vagal maneuvers, adenosine, verapamil, and cardioversion was evaluated on Tachycardia termination. Stepwise management with vagal maneuvers, adenosine, verapamil, and cardioversion was ineffective in terminating an incessant wide complex tachycardia in a 26-year-old male.
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