Palpitations after a MAZE Procedure: Difference between revisions

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m (New page: {{NHJ| |mainauthor= '''A.A.M. Wilde, H.H.D. Idzerda''' |edition= 2005:02,72 }} Figure 1|thumb A 75-year-old lady presented with palpitations. Her med...)
 
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[[Puzzle_20075_2_072_Answer|Answer]]
[[Puzzle_20075_2_072_Answer|Answer]]
The initial four beats on the electrocardiogram are
compatible with sinus rhythm at a slightly irregular
rate. After the 4th beat an extrasystole initiates a narrow
QRS complex tachycardia with a cycle length of 340
ms (rate of ±180 beats/min). The initiating P wave
has a different morphology than the sinus P wave. Its
morphology is (also) positive in the inferior leads and
negative in lead aVL, indicating a left atrial superior
origin. The same P wave is presumably superimposed
on the T wave of the subsequent beats (in lead aVL the
negative P wave seems clearly discernable).
Based on the morphology of the P wave the most
likely diagnosis is a left atrial tachycardia, which is not
an uncommon finding after a MAZE procedure. An
alternative diagnosis could be AV nodal reentrant
tachycardia but this is usually initiated by an atrial
extrasystole with a long PR interval (the ‘slow pathway’)
followed by a retrograde P wave (conducted through
the ‘fast pathway’). The morphology and timing of
the P wave are not compatible with common type AV
nodal reentrant tachycardia or uncommon type AV
nodal reentrant tachycardia (the morphology in
particular). An orthodromic AV reentry tachycardia
(with a concealed bypass) is not likely either because
of the presumable positive P wave in the inferior leads.
In summary, the most likely diagnosis is a left atrial
tachycardia post MAZE procedure.

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