Key result
Radiofrequency ablation successfully eliminates an anterograde-conducting right postero-septal accessory pathway.
Why the study?
The differential diagnosis of wide complex tachycardias is challenging but essential for correct diagnosis and treatment, especially to distinguish pre-excited atrial flutter from ventricular tachycardia.
Case Report (n=1)
This case highlights the critical importance of careful ECG analysis in differentiating wide complex tachycardias, as recognizing pre-excited atrial flutter dictates ablation as first-line therapy over contraindicated AV nodal blocking agents.
Ablation eliminated the pathway in this pre-excited flutter case; single report leaves open generalizability to practice.
BACKGROUND: The differential diagnosis of wide complex tachycardias can be challenging but is essential for correct diagnosis and treatment. CASE SUMMARY: We describe the case of a patient presenting with 2 wide complex tachycardias, both with left bundle branch block-like morphology, left superior axis, and slurred onset. The diagnosis of pre-excited atrial flutter with 1:1, respectively, 2:1 conduction was made after careful analysis of the tracings. Electrocardiogram in sinus rhythm showed short PR but inapparent pre-excitation. An invasive electrophysiological study confirmed an anterograde-conducting right postero-septal pathway, and radiofrequency ablation was performed successfully. DISCUSSION: Pre-excited atrial flutter may mimic ventricular tachycardia and represents an important diagnostic challenge with significant therapeutic implications. TAKE-HOME MESSAGES: This case highlights the importance of correct differential diagnosis of wide complex tachycardias, as management strategies differ substantially. Careful electrocardiogram analysis is essential, as pre-excitation may be inapparent in sinus rhythm even for high-risk accessory pathways.
No takes yet. Share an insight, caveat, or question.
Suran et al. (2026) conducted a case report in Wide QRS Tachycardia / Pre-excited atrial flutter (n=1). Radiofrequency ablation was evaluated. An invasive electrophysiological study confirmed an anterograde-conducting right postero-septal pathway, which was successfully treated with radiofrequency ablation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: