Key result
Intravenous metoprolol terminates sustained wide complex tachycardia confirmed as SVT with aberrancy.
Why the study?
Wide complex tachycardia in patients with structural heart disease is often presumed to be ventricular tachycardia, but supraventricular tachycardia with aberrant conduction remains an important diagnostic consideration.
Case Report (n=1)
Systematic evaluation comparing baseline QRS morphology to tachycardia QRS morphology is critical for differentiating SVT with aberrancy from VT in patients with structural heart disease, helping to prevent inappropriate therapies.
ECG comparison aids SVT-with-aberrancy diagnosis in structural heart disease; single-case data leave beta-blocker utility open for confirmation.
BACKGROUND: Wide complex tachycardia (WCT) in patients with structural heart disease is often presumed to be ventricular tachycardia (VT). However, supraventricular tachycardia with aberrant conduction accounts for a substantial proportion of WCT presentations and remains an important diagnostic consideration. CASE SUMMARY: A 74-year-old man with nonischemic cardiomyopathy and cardiac resynchronization therapy-defibrillator underwent cardioversion for persistent atrial fibrillation. Several hours later, he developed sustained WCT initiated by a premature ventricular complex. Although initially concerning for monomorphic VT, careful comparison with underlying baseline nonpaced electrocardiograms demonstrated nearly identical QRS morphology. Tachycardia terminated with 5 mg intravenous metoprolol. DISCUSSION: This case highlights key electrocardiographic principles for differentiating VT from supraventricular tachycardia with aberrancy in patients with paced QRS, the diagnostic value of baseline QRS comparison, and important limitations of morphological Brugada criteria and device detection algorithms. TAKE-HOME MESSAGE: Systematic underlying electrocardiogram analysis remains critical in the evaluation of WCT, to prevent inappropriate therapies.
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Kaiwan et al. (2026) conducted a case report in Wide complex tachycardia (n=1). Intravenous metoprolol was evaluated on Termination of tachycardia. Administration of 5 mg intravenous metoprolol abruptly terminated sustained wide complex tachycardia that was diagnosed as supraventricular tachycardia with aberrancy via baseline ECG comparison.
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