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Vol. 71. Issue 9.
Pages 754 (September 2018)
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Vol. 71. Issue 9.
Pages 754 (September 2018)
ECG Contest
DOI: 10.1016/j.rec.2018.01.022
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Response to ECG, August 2018
Respuesta al ECG de agosto de 2018
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Ana Andrés Lahuerta
Corresponding author
anaandreslahuerta@gmail.com

Corresponding author:
, Joaquín Osca Asensi, Víctor José Donoso Trenado
Departamento de Cardiología, Unidad de Arritmias, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Rev Esp Cardiol. 2018;71:67110.1016/j.rec.2018.01.021
Ana Andrés Lahuerta, Joaquín Osca Asensi, Víctor José Donoso Trenado
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The ECG recording during tachycardia shows a longer QRS interval than in sinus rhythm (115ms). There are differences in the QRS morphology of tachycardia (90° axis during tachycardia vs 30° in sinus rhythm; negative complex in leads I and aVL in tachycardia vs positive complex in sinus rhythm) without meeting the criteria for aberrant conduction (Figure 1). Supraventricular tachycardia is ruled out (answers 1 and 2, incorrect). Prior to adenosine administration, a notched T wave can be observed in the lower leads, which could correspond to an atrial mechanism. An atrial/ventricular ratio of 1:1 is observed (Figure 2A). After adenosine administration, which interrupts ventriculoatrial conduction, atrioventricular dissociation can be observed (Figure 2B), confirming that this is ventricular tachycardia with 1:1 ventriculoatrial conduction (there is an effect of adenosine on the tachycardia but without conversion to sinus rhythm, thus ruling out option 3). The correct answer is therefore number 4: the electrophysiological diagnosis was idiopathic right ventricular outflow tract tachycardia.

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