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Vol. 72. Issue 12.
Pages 1080 (December 2019)
Vol. 72. Issue 12.
Pages 1080 (December 2019)
ECG Contest
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Response to ecg, november 2019
Respuesta al ECG de noviembre de 2019
M. Rocío Gómez-Domínguez
Corresponding author

Corresponding author:
, Miguel E. Jáuregui-Abularach, Albina Aldomá-Balasch
Servicio de Cardiología, Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain
Related content
Rev Esp Cardiol. 2019;72:96610.1016/j.rec.2018.12.011
M. Rocío Gómez-Domínguez, Miguel E. Jáuregui-Abularach, Albina Aldomá-Balasch
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Diagnostic certainty in these tachycardias is not possible with the 2 main differential diagnostic algorithms (Figure 1A), given that they yield different results: the Brugada algorithm suggests a process with a ventricular origin whereas the Vereckei one points to a supraventricular origin; therefore, responses 1 and 2 are incorrect.1

Figure 1

Figure 1B shows the ECG after resolution of the tachycardia. This is consistent with atrial flutter with 2:1 atrioventricular conduction and common atrial flutter with F wave morphology/polarity. During atrial stimulation with isoproterenol, electrophysiological study showed his-Purkinje axis aberrancy with a QRS complex very similar to that of the tachycardia (Figure 2A). The supraventricular origin was confirmed by the intracavitary electrogram (Figure 2B). Therefore, this is a 1:1 conduction atrial flutter with right branch and left bundle branch aberrancy, causing right shift of QRS axis (response 3 is incorrect, response 4 is correct). The cavotricuspid isthmus was successfully ablated.

Figure 2
E. Kaiser, F.C. Darrieux, S.A. Barbosa, et al.
Differential diagnosis of wide QRS tachycardias: comparison of two electrocardiographic algorithms.
Europace., 17 (2015), pp. 1422-1427
Copyright © 2019. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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