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The ECGs show a wide complex, irregularly irregular tachycardia. An accessory pathway was identified and was ablated. The patient has not had any recurrent episodes of atrial fibrillation and has a narrow QRS complex without delta wave on his ECG post ablation. So he was simply discharged without EP study.
We see a regular tachycardia with a narrow QRS complex and no evidence of OMI or subendocardial ischemia. The differential of a regular narrow QRS tachycardia is sinus tachycardia, SVT, and atrial flutter with regular conduction. Now the patient is in sinus tachycardia. Her initial EKG is below. Same as initial ECG.
Our electrophysiologist, Rehan Karim, states he has ablated AVNR"T" ("T" because it is not tachycardia) in a 90 year old, and that he has seen rate-related BBB at very slow rates. The second explanation (AIVR), whether as a reperfusion dysrhythmia or not, seems most likely.
Here is his 12-lead: There is a wide complex tachycardia with a rate of 257, with RBBB and LPFB (right axis deviation) morphology. Read about Fascicular VT here: Idiopathic Ventricular Tachycardias for the EM Physician Case Continued He was completely stable, so adenosine was administered. See Learning point 1 below.
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