Sinus Tachycardia With Variable QRS Morphology

Accepted Manuscript Sinus Tachycardia with Variable QRS Morphology Darrin M. Breaux, MD, D. Luke Glancy, MD PII:

S0002-9149(17)30794-4

DOI:

10.1016/j.amjcard.2017.04.055

Reference:

AJC 22617

To appear in:

The American Journal of Cardiology

Received Date: 20 April 2017 Accepted Date: 20 April 2017

Please cite this article as: Breaux DM, Glancy DL, Sinus Tachycardia with Variable QRS Morphology, The American Journal of Cardiology (2017), doi: 10.1016/j.amjcard.2017.04.055. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Sinus Tachycardia with Variable QRS Morphology

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Darrin M. Breaux, MD,a and D. Luke Glancy, MDb*

Cardiology Department of Our Lady of the Lake Hospital, Baton Rouge, LA, and bthe Section

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of Cardiology, Department of Medicine, LSU Health Sciences Center, New Orleans, Louisiana

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E-mail address: [email protected]

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*Corresponding author: Tel: (985) 796-1550, fax: (504) 568-2127.

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The ECG in Figure 1 was obtained 4 days after aortic valve replacement for symptomatic stenosis (peak systolic gradient, 80 mmHg) in a 67-year-old man with hyperlipidema, diabetes mellitus, and a history of systemic hypertension. He had undergone a 3-vessel coronary arterial

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bypass operation 17 years earlier.

The cardiac rhythm is sinus tachycardia at a rate of 105 beats per minute. Complexes with a PR interval of 0.16 seconds and Q waves of an inferior myocardial infarct, old by history,

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are mixed, most often in a bigeminal pattern, with complexes having a PR interval of 0.12

seconds, a QRS of 0.13 seconds, and a prominent delta wave, best seen in the precordial leads.

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Thus, ventricular depolarizations occurring predominantly by way of an accessory pathway of the Wolff-Parkinson-White (WPW) type are nearly as common as those occurring predominantly by way of the normal atrioventricular conduction system. The latter show wide (0.115 seconds) QRSs because of the ventricular conduction abnormality resulting from the inferior infarct.

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WPW-type ventricular preexcitation is commonly intermittent, with prevalences of up to 90% depending on how exhaustive the search for intermittence has been.1,2 In this patient no WPW-type preexcitation was found on 7 ECGs recorded 2 years earlier or on one recorded 3

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References

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days later.

1. Murdock CJ, Klein GJ, Yee R, Leitch JW. Management of the patient with the WolffParkinson-White syndrome. Cardiology 1990;77(3):151-165. 2. Klein GJ, Gulamhusein SS. Intermittent preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol 1983;52(3):292-296.

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Figure Legend 1. ECG recorded 4 days after aortic valve replacement for symptomatic aortic stenosis. See

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text for explication.

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Short Title: Variable QRS morphology

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