AV nodal reentrant tachycardia with a 2:1 right bundle branch block missed as bidirectional ventricular tachycardia in the first superficial evaluation

Open access

Abstract

A 95-year old woman was admitted to our emergency unit because of acute abdominal pain. After urgent surgery according to the acute abdomen, she was referred to intensive care unit (ICU) of the emergency unit as she was intubated. It was developed a run of new arrhythmia which was diagnosed by cardiology resident as bidirectional ventricular tachycardia due to beat to beat changing the axis of the QRS. However, a second and more precise evaluation of the abnormal ECG suggested a narrow supraventricular tachycardia, most probably AV nodal reentrant tachycardia with a 2:1 right bundle branch block.

1. RICHTER S., BRUGADA P. Bidirectional ventricular tachycardia. J Am Coll Cardiol. 2009; 54(13):1189.

2. BERTE B., EYSKENS B., MEYFROIDT G., WILLEMS R. Bidirectional ventricular tachycardia in fulminant myocarditis. Europace. 2008; 10(6):767-8.

3. DORFMAN FK., MESAS CE., CIRENZA C., DE PAOLA AA. Bidirectional ventricular tachycardia with alternating right and left bundle branch block morphology in a patient with metastatic cardiac tumors. J Cardiovasc Electrophysiol. 2006; 17(7):784-5.

4. VERECKEI A., TENCZER J. Intermittent left bundle branch block: what is the mechanism? J Cardiovasc Electrophysiol. 2003; 14(9):1010-2.

5. BAROLD HS., NEWMAN M., FLANAGAN M., BAROLD SS. Two-to-one bundle branch block during atrioventricular nodal reentrant tachycardia: what is the mechanism? Heart Rhythm. 2007; 4(3):371-3.

6. SHINDE RS., CARBONE V., SHINDE SN., ORETO G. Right bundle branch block on alternate beats during acute pulmonary embolism. Ann Noninvasive Electrocardiol. 2011; 16(3):311-4.

7. CARBONE V., CARERJ S., CALABRO MP. Bundle branch block on alternate beats during atrial fibrillation. J Electrocardiol. 2004; 37(1):67-72.

8. LUZZA F., CALABRO MP., CARERJ S., ORETO G. Bundle branch block in alternate beats during 2:1 atrial flutter. J Electrocardiol. 2006; 39(1):38-41.

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 170 163 6
PDF Downloads 90 87 4