Challenging wide QRS tachycardia diagnosis: One trigger two mechanisms

TL;DR

A rare case of two different heart rhythm disorders triggered by the same event is successfully treated, highlighting the complexity of diagnosing and managing wide QRS tachycardias.

Contribution

The paper presents a novel clinical case where two distinct tachycardia mechanisms are triggered by a single event in the right ventricular outflow tract.

Findings

A premature ventricular complex triggered both pleomorphic ventricular tachycardia and Mahaim-type antidromic tachycardia.

Eliminating the trigger improved patient stability and allowed for successful management of the tachycardias.

The case highlights the challenges in diagnosing coexisting tachycardias during an electrical storm.

Abstract

The coexistence of different types of wide QRS complex tachycardias induced by the same trigger has rarely been observed. The electrical instability and incessant nature of tachycardias can cause tachycardiomyopathy and will not allow accurate diagnosis during an electrophysiological study (EPS). In case of an electrical storm, elimination of the trigger may be the first approach to provide patient stability. We report a successfully managed case of repetitive initiation of pleomorphic ventricular tachycardia and Mahaim-type antidromic atrioventricular reentrant tachycardia, induced by a premature ventricular complex in the right ventricular outflow tract.

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