Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2019;72:345 - Vol. 72 Num.04 DOI: 10.1016/j.rec.2018.06.018

Response to ECG, March 2019

Gunnar Leithold a,, Ginés Elvira Ruiz a, Javier Pérez Copete a

a Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain

Refers to

Free articleECG, March 2019
Gunnar Leithold, Ginés Elvira Ruiz, Javier Pérez Copete
Rev Esp Cardiol. 2019;72:247
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This is pre-excited atrial flutter with atrioventricular (AV) 2:1 conduction and 1:1 transient conduction exclusively through a left posteroseptal accessory pathway on administration of adenosine (therefore, answer 2 is correct). Although isolated cases have been reported of conduction acceleration through the AV node, probably due to direct effect of adenosine on the sympathetic system,1 the expected observation in the case of aberrant conduction would have been an increase in the degree of AV block (answer 4 incorrect). Idiopathic posterior fascicular ventricular tachycardia presents as a relatively narrow QRS tachycardia with an image of right bundle branch block with left axis deviation2; nevertheless, doubling of the heart rate is not expected with adenosine (answer 1, incorrect). Supraventricular paroxysmal AV node re-entry tachycardia usually has a typical clinical presentation and adenosine is very effective at terminating it (answer 3, incorrect). The Figure shows ECG during atrial fibrillation after ablation of the accessory pathway and the cavotricuspid isthmus.

Figure.

Corresponding author: gunnar.leithold@gmail.com

Bibliography

1. Biaggioni I, Killian TJ, Mosqueda-Garcia R, Robertson RM, Robertson D. Adenosine increases sympathetic nerve traffic in humans. Circulation. 1991;83:1668-75.
2. Ward DE, Nathan AW, Camm AJ. Fascicular tachycardia sensitive to calcium antagonists. Eur Heart J. 1984;5:896-905.

1885-5857/© 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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