Preexcitation Pitfalls (Part 2): Wide, Regular, Fast…Treat It Like VT

ECG Weekly Workout with Dr. Amal Mattu

HPI

A young man with recurrent palpitations presents to the emergency department hemodynamically stable during an episode. The arrival ECG shows a wide complex, regular tachycardia and the computer interpretation calls probable ventricular tachycardia. He converts after treatment, but then develops a narrow complex, regular tachycardia shortly afterward.

Before watching this week’s workout, review the arrival ECG carefully and consider:

    1. When you see a wide, regular tachycardia, what is the safest default rhythm assumption?
    2. In narrow, regular SVT, when is WPW most likely to reveal itself on ECG?
    3. Why is “seeing delta waves” during the tachycardia phase a setup for misdiagnosis?