Post-Operative Narrow Complex Tachycardia: What is the Mechanism?
Year: 2010
Type: article
Abstract: A 58 year old woman with symptomatic severe bicuspid aortic valve stenosis underwent aortic valve replacement with a mechanical prosthesis. On post-operative day four, the patient developed sudden onset of sustained narrow complex tachycardia with a heart rate of 170- 180 (Figure 1). She complained of palpitations, but her blood pressure remained stable. The tachycardia was able to be briefly terminated with direct current cardioversion, revealing underlying sinus rhythm, but would recur within seconds. The tachyarrhythmia was resistant to treatment with beta blockers, calcium channel blockers, amiodarone, and digoxin and remained incessant for 48 hours. What is the rhythm, and how should the patient be managed? Commentary Initial evaluation of the presenting arrhythmia (Figure 1) revealed a narrow complex tachycardia at a rate of 173 beats per minute, consistent with supraventricular tachycardia. The unusual feature of the arrhythmia was its incessant nature, whereby it would spontaneously reinitiate within seconds after successful cardioversion. A careful examination of the surface electrocardiogram in Figure 1 reveals the absence of 1:1 ventriculo-atrial (V-A) association, whereby one atrial signal could be seen for every two QRS complexes. An electrophysiology
Source: PubMed Central
Authors: Arash Arshi, Samir Saba
Institution: University of Pittsburgh Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1548606103