150 Not narrow, not wide: a 15 year old with recurrent episodes of tachyarrhythmia

Case report: A 15-year-old boy  presented to the emergency department of his district general hospital with a history of palpitations for 20 hours following a bike ride. On examination he was alert and haemodynamically stable. His ECG showed a tachycardia of 180 bpm with QRS duration of 122 ms and left axis deviation. SVT wa s presumed, hence, vagal manoeuvres and i.v. Adenosine (3mg, 6mg, 12 mg) were tried unsuccessfully. After discussion with the paediatric cardiologist he was transferred to the paediatric critical care unit for Amiodarone infusion and review by the cardiologist. The tachyarrhythmia spontaneously re verted into sinus rhythm without any further intervention. The initial ECG was re-examined and felt to be consistent with fascicular VT. Echocardiogram showed a structurally and functionally normal heart. He was discharged home on Atenolol to prevent further episodes.
Source: Europace - Category: Cardiology Source Type: research