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Vol. 73. Issue 1.
Pages 87 (January 2020)
ECG Contest
DOI: 10.1016/j.rec.2019.06.008
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ECG, January 2020
ECG de enero de 2020
Raquel Luna-López, Tomás Datino
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Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Rev Esp Cardiol. 2020;73:17210.1016/j.rec.2019.06.009
Raquel Luna-López, Tomás Datino
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A 48-year-old woman with advanced hypertrophic cardiomyopathy and restrictive physiology, several prior episodes of arrhythmia, several previous pulmonary vein ablations, and atypical flutter, underwent a heart transplant with the Shumway technique. On the second day after the transplant, the ECG shown in Figure 1 was recorded. Amiodarone bolus was administered without effect. Finally, electrical cardioversion was performed, after which, the ECG shown in Figure 2 was recorded, without (Figure 2A) and with (Figure 2B) atrial pacing with a temporary epicardial pacemaker.

Figure 1
Figure 2

What do you think was the diagnosis?

  • 1.

    Cardioversion has not occurred. The patient has atrial flutter with conduction slowed by amiodarone.

  • 2.

    Nodal escape was present due to sinus dysfunction of the graft, with atrial flutter of the native atrium.

  • 3.

    Atrial tachycardia with complete atrioventricular block occurred after electrical cardioversion.

  • 4.

    Sinus dysfunction was present with nodal escape of the graft and dissociated native sinus activity.

Submit your answer to The answer will be published in the next issue (February 2020). #RetoECG.

Copyright © 2019. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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