Successful Ablation of a Wide Complex Tachycardia with Distinct
Intra-Cardiac Electrograms
Abstract
A 13-year-old boy was hospitalized after a syncopal episode that
occurred during exercise. He suddenly felt chest tightness, sweating and
palpitations, followed by a transient loss of conciseness. Upon
emergency medical team arrival, he was awake and oriented. Baseline ECG
showed sinus rhythm at a rate of 98 bpm, with narrow QRS, and no signs
of long QT, Brugada, or pre-excitation. Physical examination, blood
tests, 24 hours Holter monitoring, transthoracic echocardiography and
stress test were all within normal limits. Eight days later he
experienced a second episode of palpitations while walking to school.
ECG revealed regular wide complex tachycardia (WCT) at a rate of 200
bpm, with LBBB morphology that terminated with Adenosine (Figure 1). The
clinical tachycardia was easily induced by programmed electrical
stimulation (Figure 2A). Diagnostic electrophysiological maneuver
(Figure 2B) was followed by successful ablation, during which a unique
phenomenon was noted (Figure 3). What is the diagnosis of the
tachycardia and what are the unique findings noted during and after
ablation?