This post is an answer to the ECG Case 310
- Rate: ~200 bpm
- Rhythm: Regular
- Axis: Normal
- Intervals: QRS – Normal (50ms)
- Segments: ST Depression in leads I, II, V2-6
- Additional:
- Notching terminal QRS best seen leads I and aVR
- Negative QRS in lead III
- Associated T wave inversion on sinus ECG below
- Possible LA / LL reversal
- Results in negative III
- Leads I and II switch places
- Leads aVL and aVF switch places
Interpretation
- Narrow complex regular tachycardia
- LA / LL lead reversal ?
General differentials for a regular narrow complex tachycardia are:
- Sinus tachycardia
- AVNRT
- AVRT
- Atrial tachycardia
- Atrial flutter
- Sinus node re-entry tachycardia
- Junctional tachycardia
What happened next?
The patient had a prior ablation for recurrent AVNRT several years prior and remained symptom free till this episode. Following administration of 6mg IV Adenosine she reverted to sinus rhythm, ECG below. She was then discharged for out-patient follow-up with her regular cardiologist.
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