Irregular wide QRS complex tachycardia without structural heart disease
Key result
IV procainamide successfully terminates AF in a patient with WPW syndrome prior to catheter ablation.
- n=1
Why the study?
Irregular wide QRS complex tachycardia without structural heart disease presents diagnostic and therapeutic challenges, particularly in distinguishing atrial fibrillation in WPW syndrome from other arrhythmias.
Population
A 64-year-old female with 30-year history of palpitations and ECG abnormalities
Comparison
Intravenous procainamide followed by catheter ablation
Design
Case report
Authors
Discussion
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Member takes
Implication
Single-case report of unstable tachyarrhythmia; leaves open whether ECG pattern alters management in chronic palpitations.
Key Points
- To describe the differential diagnosis, acute pharmacologic termination, and definitive treatment of irregular wide QRS complex tachycardia in Wolff-Parkinson-White syndrome.
- Evaluated a 64-year-old female presenting with dizziness, hypotension (90/40 mmHg), and tachycardia (130–270 bpm) using 12-lead electrocardiography, echocardiography, and laboratory diagnostics.
- Administered intravenous procainamide (400 mg over 30 minutes) to terminate atrial fibrillation and block accessory pathway conduction, followed by referral for catheter ablation.
- Initial 12-lead ECG revealed wide QRS tachycardia (150–300 bpm) with beat-to-beat morphological variation and a shortest R–R interval of ~200 ms, denoting a high risk of ventricular fibrillation.
- Intravenous procainamide successfully restored sinus rhythm, unmasking delta waves indicative of a left-sided accessory pathway, which was subsequently treated via radiofrequency catheter ablation.
Study Design
Type
Case Report (n=1)
Structured PICO
P
Population
A 64-year-old female presenting with persistent dizziness and irregular wide QRS complex tachycardia diagnosed as atrial fibrillation with Wolff-Parkinson-White syndrome.
I
Intervention
Intravenous procainamide 400 mg over 30 minutes, followed by catheter ablation.
O
Outcome
Termination of atrial fibrillation and conversion to normal sinus rhythm.
Intravenous procainamide successfully terminated atrial fibrillation in a hemodynamically stable patient with Wolff-Parkinson-White syndrome, avoiding contraindicated AV nodal blocking agents.
Cite This Study
Kobayashi et al. (2012) conducted a case report in Atrial fibrillation in Wolff-Parkinson-White (WPW) syndrome (n=1). Intravenous procainamide was evaluated on Conversion to normal sinus rhythm. Intravenous procainamide successfully terminated atrial fibrillation in a 64-year-old female with Wolff-Parkinson-White syndrome, converting her to normal sinus rhythm prior to catheter ablation.