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Gepubliceerd in: Netherlands Heart Journal 7-8/2019

Open Access 21-05-2019 | Rhythm Puzzle – Question

Between Scylla and Charybdis

Auteurs: H. J. te Kolste, G. J. Kimman, T. Germans, S. A. J. Timmer

Gepubliceerd in: Netherlands Heart Journal | Uitgave 7-8/2019

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A 69-year-old patient presented at the emergency department after experiencing near-syncope. He was known at the outpatient clinic with a Wolff-Parkinson-White (WPW) pattern seen on electrocardiogram (ECG) and was previously asymptomatic. The ECG at rest showed sinus rhythm with right bundle branch block (RBBB) and left anterior fascicular block (LAFB), alternating with a pre-excited QRS-complex morphology consistent with a left lateral and/or anterolateral insertion of the accessory pathway (Fig. 1). Additional investigations (laboratory studies, echocardiography) were unremarkable. During 48-hour telemetric observation no impulse or conduction abnormalities (other than intermittent pre-excitation) and no tachyarrhythmias were observed. Exercise testing resulted in aggravation of ventricular pre-excitation at increasing heart rate (>100 bpm). Subsequently, the patient was started on flecainide to increase refractoriness of the accessory pathway and was scheduled for electrophysiological studies. Six weeks later, the patient suffered from syncope resulting in a fracture of the left humerus. What does the ECG on admission show (Fig. 2)?

Answer

You will find the answer elsewhere in this issue.
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Netherlands Heart Journal

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Metagegevens
Titel
Between Scylla and Charybdis
Auteurs
H. J. te Kolste
G. J. Kimman
T. Germans
S. A. J. Timmer
Publicatiedatum
21-05-2019
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 7-8/2019
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-019-1289-3

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