Case 118: A 57 Year-Old Man with Palpitations
History
Diagnosis
History
A 57yr man undergoes a Holter monitor (shown below) after complaining of intermittent sudden onset, sudden offset palpitations.
Diagnosis
- Sinus Rhythm
- Premature Atrial Beat initiates Supraventricular Tachycardia with “long RP”
- Premature Ventricular Beat terminates Supraventricular Tachycardia
Comment: The first panel shows sinus rhythm followed by a PAC (denoted by “P”) which initiates a tachycardia. The tachycardia has a long RP, meaning the QRS to P interval is longer than the P to QRS interval. The main differential diagnosis of this tachycardia is (1) atrial tachycardia, (2) atypical (fast-slow) AVNRT, (3) AVRT secondary to a decrementally conducting accessory pathyway. Termination of the tachycardia with a PVC (denoted by “V” in third panel) is against atrial tachycardia. This patient was taken to the EP lab and found to have both typical and atypical AVNRT.
ECG ID: E829