Panduranga Prashanth, Al-Farqani Abdullah, Al-Rawahi Najib
Department of Adult Congenital Heart Disease, , Royal Hospital, Muscat, Oman.
Pediatr Emerg Care. 2012 Nov;28(11):1227-9. doi: 10.1097/PEC.0b013e31827208c5.
A 10-year-old girl presented to the emergency department of a regional hospital with 1 episode of generalized tonic-clonic seizures. Postictal monitoring followed by a 12-lead electrocardiogram showed fast atrial fibrillation with intermittent wide QRS regular tachycardia. Immediately following this, her rhythm changed to wide QRS irregular tachycardia without hemodynamic compromise. She was suspected to have ventricular tachycardia and was treated with intravenous amiodarone with cardioversion to sinus rhythm. Subsequent electrocardiogram in sinus rhythm showed typical features of manifest Wolff-Parkinson-White (WPW) accessory pathway. This case illustrates the diagnostic and therapeutic dilemmas in patients with atrial fibrillation, wide QRS tachycardia, and undiagnosed WPW syndrome with antidromic conduction of atrial arrhythmias through the accessory pathway. Furthermore, this case demonstrates that undiagnosed wide QRS tachycardias need to be treated with drugs acting on the accessory pathway, thus keeping in mind underlying WPW syndrome as a possibility to avoid potentially catastrophic events.
一名10岁女孩因1次全身性强直阵挛发作被送往一家地区医院的急诊科。发作后监测并进行12导联心电图检查显示快速房颤伴间歇性宽QRS规则性心动过速。紧接着，她的心律变为宽QRS不规则性心动过速，且无血流动力学损害。她被怀疑患有室性心动过速，并接受了静脉注射胺碘酮治疗，心律转复为窦性心律。窦性心律时的后续心电图显示出显性预激综合征（WPW）旁路的典型特征。该病例说明了房颤、宽QRS心动过速且未诊断出WPW综合征的患者中，房性心律失常通过旁路进行逆向传导时的诊断和治疗困境。此外，该病例表明，对于未诊断出的宽QRS心动过速，需要使用作用于旁路的药物进行治疗，因此要牢记潜在的WPW综合征，以避免可能发生的灾难性事件。
