Aberrancy masquerading as ventricular tachycardia: Importance of invasive electrophysiology study for diagnosis of wide complex tachycardias.

Autor: William J; The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia., Kistler PM; The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia., Kalman JM; The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia., Scheinman M; Department of Medicine, University of California, San Francisco, CA, USA., Sugumar H; The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia., Prabhu S; The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia., Ling LH; The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia., Vedantham V; Department of Medicine, University of California, San Francisco, CA, USA., Tseng Z; Department of Medicine, University of California, San Francisco, CA, USA., Moss J; Department of Medicine, University of California, San Francisco, CA, USA., Gerstenfeld EP; Department of Medicine, University of California, San Francisco, CA, USA., Voskoboinik A; The Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Royal Melbourne Hospital, Melbourne, Australia. Electronic address: a.voskoboinik@alfred.org.au.
Jazyk: angličtina
Zdroj: Journal of electrocardiology [J Electrocardiol] 2024 Jul-Aug; Vol. 85, pp. 50-57. Date of Electronic Publication: 2024 Jun 08.
DOI: 10.1016/j.jelectrocard.2024.05.099
Abstrakt: Background: Differentiation between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with aberrancy based on the 12‑lead ECG alone can be imprecise. Implantable cardiac defibrillators (ICD) may be inserted for presumed VT, particularly in patients with syncopal presentation or atypical aberrancy patterns. Accurate diagnosis of these patients facilitated by an electrophysiology study (EPS) may alter diagnosis and management.
Methods: We present a prospective collection of cases across 3 cardiac centers of consecutive patients with WCT presumed to be VT who were referred for consideration of an ICD, and in whom further evaluation including an EPS ultimately demonstrated SVT with aberrancy as the culprit arrhythmia.
Results: 22 patients were identified (17 male, mean age 50±13 years. Available rhythm data at the time of referral was presumptively diagnosed as monomorphic VT in 16 patients and polymorphic VT in 6 patients. Underlying structural heart disease was present in 20 (91%). EPS resulted in a diagnosis of SVT with aberrancy in all cases: comprising AV nodal re-entry tachycardia (n=10), orthodromic reciprocating tachycardia (n=3), focal atrial tachycardia (n=3), AF/AFL (n=3) and 'double fire' tachycardia (n=2). 21 (95%) patients underwent successful ablation. All patients remained free of arrhythmia recurrence at a median of 3.4 years of follow-up. ICD insertion was obviated in 18 (82%) patients, with 1 patient proceeding to ICD extraction.
Conclusion: SVT with atypical aberrancy may mimic monomorphic or polymorphic VT. Careful examination of all available rhythm data and consideration of an EPS can confirm SVT and obviate the need for ICD therapy.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Aleksandr Voskoboinik reports was provided by Alfred Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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