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14-12-2018 | Rhythm Puzzle – Question | Uitgave 2/2019 Open Access

Netherlands Heart Journal 2/2019

An irregular narrow complex tachycardia: atrial fibrillation or something else?

Tijdschrift:
Netherlands Heart Journal > Uitgave 2/2019
Auteurs:
M. J. Mulder, C. P. Allaart, H. A. Hauer, M. J. B. Kemme
A 44-year-old female patient was referred to our centre for pulmonary vein isolation. Her medical history was significant for hypothyroidism. She was taking levothyroxine and was clinically euthyroid with a free T4 of 19.9 pmol/l (12–22 pmol/l) and a thyroid-stimulating hormone level of 4.5 mU/l (0.3–4.5 mU/l). She experienced daily episodes of palpitations, not responding to antiarrhythmic drug therapy (sotalol or flecainide). Episodes were self-terminating within an hour of onset, without performing vagal manoeuvres. A 12-lead electrocardiogram was acquired during palpitations, which revealed an irregular narrow complex tachycardia that was previously diagnosed as atrial fibrillation (Fig. 1). Structural heart disease was excluded by transthoracic echocardiography. Based on this ECG an electrophysiology study was scheduled. During placement of the catheters, spontaneous initiation of an irregular tachycardia occurred (Fig. 2). What is the mechanism of this tachycardia?

Answer

You will find the answer elsewhere in this issue.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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