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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 50-year-old patient with several episodes of syncope and documented simultaneous wide and narrow QRS complex tachycardia&#46; We then review this tachyarrhythmia&#44; focusing on electrophysiological findings and pathophysiology&#44; diagnosis and treatment&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 50-year-old man presented to the emergency department due to an episode of palpitations and dizziness&#46; He reported several episodes of sudden syncope&#46; The standard 12-lead electrocardiogram &#40;ECG&#41; performed on admission showed a wide QRS complex tachycardia&#44; which changed spontaneously into a narrow QRS complex tachycardia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41; and vice versa&#46; Blood pressure during the episode was 90&#47;65mmHg&#46; Due to the fact that the tachycardia was repetitive&#44; bisoprolol was administered intravenously and sinus rhythm was restored&#46; An emergency echocardiogram revealed no evidence of structural heart disease&#46; An electrophysiological study &#40;EPS&#41; was subsequently performed&#46; A bipolar catheter was placed initially in the right ventricular &#40;RV&#41; apex &#40;afterwards withdrawn towards the His position&#41; and a quadripolar catheter in the coronary sinus &#40;CS&#41;&#46; Ventricular stimulation performed from the right RV apex showed decremental retrograde conduction with a proximal to distal activation sequence in the CS&#46; Programmed atrial stimulation revealed a dual AV nodal physiology with an AH jump and subsequent induction of atrioventricular nodal reentrant tachycardia &#40;AVNRT&#41;&#46; The diagnosis of AVNRT was based on the long postpacing interval &#40;PPI&#41; during entrainment of the tachycardia from the RV apex &#40;PPI-TCL&#61;180ms&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#44; septal VA interval of -10ms &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#44; a stimulus-atrial &#40;during pacing from the RV apex&#41; minus ventriculo-atrial &#40;during tachycardia&#41; interval greater than 85ms&#44; and absence of fusion during entrainment of the tachycardia&#46; As in the baseline ECG&#44; runs of wide QRS complex tachycardia with left bundle brunch morphology &#40;LBBB&#41; interacting with the narrow QRS tachycardia were also observed&#46; The intracardiac signal during the latter confirmed that it was a ventricular tachycardia &#40;VT&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41; &#40;VA dissociation&#44; without anterograde His potential&#41;&#46; Another interesting finding was the absence of atrial advancement by spontaneous single ventricular extrastimuli when the His bundle was refractory &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>C&#41;&#46; Transient entrainment of the AVNRT by non-sustained VT was also seen&#46; During this phenomenon&#44; the interval from the last beat of the VT to the first beat of the SVT minus the tachycardia cycle length &#40;TCL&#41; &#91;&#40;V<span class="elsevierStyleInf">VT</span> &#8722; V<span class="elsevierStyleInf">SVT</span>&#41; &#8722; TCL&#93; was longer than 115ms &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>C and D&#41;&#44; suggesting AVNRT&#44; and making the diagnosis of an orthodromic septal tachycardia unlikely&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Based on these observations&#44; radiofrequency catheter ablation of the slow pathway region was performed using a 4-mm non-irrigated bidirectional catheter &#40;Biosense Webster&#44; Diamond Bar&#44; CA&#41;&#46; Post-ablation programmed atrial and ventricular stimulation failed to induce any supraventricular tachycardia even under isoproterenol infusion&#46; However&#44; premature ventricular complexes &#40;PVC&#41; and a wide QRS complex tachycardia identical to the initial one were induced&#46; Because the patient was extremely symptomatic&#44; the decision was taken to ablate the ventricular focus&#46; The twelve-lead ECG suggested a septal origin of the tachycardia in the right ventricular outflow tract &#40;RVOT&#41; with a predominant R and small S wave in I and tall S waves in V1&#47;V2&#44; with transition in the precordial leads &#40;R&#47;S&#8805;1 by V4&#41;&#46; Furthermore&#44; the PVC precordial transition occurred later than the sinus rhythm transition&#44; excluding a left ventricular outflow tract origin&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a> The ablation catheter was then placed in the subpulmonary septal RVOT for mapping and ablation&#46; The PVC and the VT could not be further induced&#44; perhaps due to mechanical pressure &#40;&#8220;bump termination&#8221;&#41;&#46; As conventional local activation mapping was not possible&#44; pace-mapping was performed from this stable septal RVOT&#44; which revealed 12&#47;12 lead concordance with the PVC&#47;VT &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; Moreover&#44; ablation at this point unleashed runs of PVC and non-sustained tachycardia with QRS morphology similar to that seen during spontaneous VT&#44; which terminated during radio frequency application with 50W and 55<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Thirty minutes after ablation&#44; no tachycardia was induced either with or without isoproterenol and there was no recurrence during 12 months of follow-up&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">We describe the fascinating electrophysiological interplay between a narrow and a wide QRS tachycardia&#46; Interestingly&#44; the two different tachycardias did not occur simply by coincidence&#44; but showed a degree of mutual interdependence in inducing&#44; resetting and terminating each other&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This association &#40;RVOT VT&#47;AVNRT&#41; is a case of double tachycardia&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It is reported to occur more often in patients with poor left ventricular function or in association with digoxin treatment&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">1&#44;3</span></a> but it has also been described in patients without known structural heart disease<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#59; in fact&#44; Kautzner et al<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> reported that 15&#37; of patients with clinically documented idiopathic outflow tract VT were also found to have reproducibly inducible AVNRT at the time of the EPS&#46; Additionally&#44; it has also been postulated that concealed retrograde engagement of the AV node could occur&#44; allowing the next anterograde impulse to depolarize the ventricle via the slow pathway and thus initiate tachycardia&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Finally&#44; RVOT tachycardia is a triggered arrhythmia&#44; whose induction would be favored by the high catecholamine levels which can occur during AVNRT&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">From the electrophysiological point of view it is worth analyzing the response after the transient &#8220;entrainment&#8221; of the AVNRT by the non-sustained ventricular tachycardia&#46; During the latter&#44; the atrial cycle length accelerated to the VT cycle length and the narrow tachycardia resumed after the VT spontaneously stopped&#46; We suggest that similar information to that obtained during the ventricular entrainment of SVT could also be inferred from spontaneous transient entrainment of an AVNRT by a VT &#91;&#40;V<span class="elsevierStyleInf">VT</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>VSVT&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>TCL&#93;&#44; to the best of our knowledge never previously described&#46; This is in favor of an AVNRT rather than orthodromic tachycardia &#40;AVRT&#41; due to the long &#91;&#40;V<span class="elsevierStyleInf">VT</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>V<span class="elsevierStyleInf">SVT</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>TCL&#93; interval &#40;140ms-160ms&#41;&#44; similar to the PPI-TCL measurement&#44; which is also supported by the absence of atrial advancement by the spontaneous occurring PVC when the His bundle was refractory&#46; The VAV response also helps to rule out an atrial tachycardia&#46; In this regard&#44; during the VT runs and the subsequent SVT&#44; the first VA after the narrow QRS tachycardia was always fixed&#44; regardless of the different cycle lengths of the RVOT-VT&#44; another clue that helps to rule out an atrial tachycardia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D and E&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The fact that the syncope disappeared after ablation is interesting&#46; As is known&#44; syncope often has multiple contributory factors&#46; In the present case&#44; the high heart rate during orthostatism and a possible inadequacy of vascular compensation could have contributed to the syncope episodes&#46; However&#44; this is only supposition and the exact mechanism cannot be completely explained&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To summarize&#44; in such situations&#44; in which during tachycardia there is intermittent widening of the QRS&#44; care should be taken to not classify it as a simple transient aberrancy&#46; Subsequent analysis looking for clues pointing towards the presence of a double tachycardia should be taken into account&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human and animal subjects</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">Dr&#46; Mois&#233;s Rodr&#237;guez-Ma&#241;ero is funded by a post-residency grant on clinical electrophysiology from the European Society of Cardiology&#46;</p></span></span>"
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Case report
Simultaneous wide and narrow QRS complex tachycardia: what is the mechanism?
Moisés Rodríguez-Mañero
Autor para correspondência
mrodrig3@hotmail.com

Corresponding author.
, Fatih Bayrak, Mehdi Namdar, Rubén Casado-Arroyo, Danilo Ricciardi, Gian-Battista Chierchia, Andrea Sarkozy, Carlo de Asmundis, Pedro Brugada
Cardiovascular Division, UZ Brussel-VUB, Brussels, Belgium
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    "titulo" => "Simultaneous wide and narrow QRS complex tachycardia&#58; what is the mechanism&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 50-year-old patient with several episodes of syncope and documented simultaneous wide and narrow QRS complex tachycardia&#46; We then review this tachyarrhythmia&#44; focusing on electrophysiological findings and pathophysiology&#44; diagnosis and treatment&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 50-year-old man presented to the emergency department due to an episode of palpitations and dizziness&#46; He reported several episodes of sudden syncope&#46; The standard 12-lead electrocardiogram &#40;ECG&#41; performed on admission showed a wide QRS complex tachycardia&#44; which changed spontaneously into a narrow QRS complex tachycardia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41; and vice versa&#46; Blood pressure during the episode was 90&#47;65mmHg&#46; Due to the fact that the tachycardia was repetitive&#44; bisoprolol was administered intravenously and sinus rhythm was restored&#46; An emergency echocardiogram revealed no evidence of structural heart disease&#46; An electrophysiological study &#40;EPS&#41; was subsequently performed&#46; A bipolar catheter was placed initially in the right ventricular &#40;RV&#41; apex &#40;afterwards withdrawn towards the His position&#41; and a quadripolar catheter in the coronary sinus &#40;CS&#41;&#46; Ventricular stimulation performed from the right RV apex showed decremental retrograde conduction with a proximal to distal activation sequence in the CS&#46; Programmed atrial stimulation revealed a dual AV nodal physiology with an AH jump and subsequent induction of atrioventricular nodal reentrant tachycardia &#40;AVNRT&#41;&#46; The diagnosis of AVNRT was based on the long postpacing interval &#40;PPI&#41; during entrainment of the tachycardia from the RV apex &#40;PPI-TCL&#61;180ms&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#44; septal VA interval of -10ms &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#44; a stimulus-atrial &#40;during pacing from the RV apex&#41; minus ventriculo-atrial &#40;during tachycardia&#41; interval greater than 85ms&#44; and absence of fusion during entrainment of the tachycardia&#46; As in the baseline ECG&#44; runs of wide QRS complex tachycardia with left bundle brunch morphology &#40;LBBB&#41; interacting with the narrow QRS tachycardia were also observed&#46; The intracardiac signal during the latter confirmed that it was a ventricular tachycardia &#40;VT&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41; &#40;VA dissociation&#44; without anterograde His potential&#41;&#46; Another interesting finding was the absence of atrial advancement by spontaneous single ventricular extrastimuli when the His bundle was refractory &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>C&#41;&#46; Transient entrainment of the AVNRT by non-sustained VT was also seen&#46; During this phenomenon&#44; the interval from the last beat of the VT to the first beat of the SVT minus the tachycardia cycle length &#40;TCL&#41; &#91;&#40;V<span class="elsevierStyleInf">VT</span> &#8722; V<span class="elsevierStyleInf">SVT</span>&#41; &#8722; TCL&#93; was longer than 115ms &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>C and D&#41;&#44; suggesting AVNRT&#44; and making the diagnosis of an orthodromic septal tachycardia unlikely&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Based on these observations&#44; radiofrequency catheter ablation of the slow pathway region was performed using a 4-mm non-irrigated bidirectional catheter &#40;Biosense Webster&#44; Diamond Bar&#44; CA&#41;&#46; Post-ablation programmed atrial and ventricular stimulation failed to induce any supraventricular tachycardia even under isoproterenol infusion&#46; However&#44; premature ventricular complexes &#40;PVC&#41; and a wide QRS complex tachycardia identical to the initial one were induced&#46; Because the patient was extremely symptomatic&#44; the decision was taken to ablate the ventricular focus&#46; The twelve-lead ECG suggested a septal origin of the tachycardia in the right ventricular outflow tract &#40;RVOT&#41; with a predominant R and small S wave in I and tall S waves in V1&#47;V2&#44; with transition in the precordial leads &#40;R&#47;S&#8805;1 by V4&#41;&#46; Furthermore&#44; the PVC precordial transition occurred later than the sinus rhythm transition&#44; excluding a left ventricular outflow tract origin&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a> The ablation catheter was then placed in the subpulmonary septal RVOT for mapping and ablation&#46; The PVC and the VT could not be further induced&#44; perhaps due to mechanical pressure &#40;&#8220;bump termination&#8221;&#41;&#46; As conventional local activation mapping was not possible&#44; pace-mapping was performed from this stable septal RVOT&#44; which revealed 12&#47;12 lead concordance with the PVC&#47;VT &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; Moreover&#44; ablation at this point unleashed runs of PVC and non-sustained tachycardia with QRS morphology similar to that seen during spontaneous VT&#44; which terminated during radio frequency application with 50W and 55<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Thirty minutes after ablation&#44; no tachycardia was induced either with or without isoproterenol and there was no recurrence during 12 months of follow-up&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">We describe the fascinating electrophysiological interplay between a narrow and a wide QRS tachycardia&#46; Interestingly&#44; the two different tachycardias did not occur simply by coincidence&#44; but showed a degree of mutual interdependence in inducing&#44; resetting and terminating each other&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This association &#40;RVOT VT&#47;AVNRT&#41; is a case of double tachycardia&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It is reported to occur more often in patients with poor left ventricular function or in association with digoxin treatment&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">1&#44;3</span></a> but it has also been described in patients without known structural heart disease<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#59; in fact&#44; Kautzner et al<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> reported that 15&#37; of patients with clinically documented idiopathic outflow tract VT were also found to have reproducibly inducible AVNRT at the time of the EPS&#46; Additionally&#44; it has also been postulated that concealed retrograde engagement of the AV node could occur&#44; allowing the next anterograde impulse to depolarize the ventricle via the slow pathway and thus initiate tachycardia&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Finally&#44; RVOT tachycardia is a triggered arrhythmia&#44; whose induction would be favored by the high catecholamine levels which can occur during AVNRT&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">From the electrophysiological point of view it is worth analyzing the response after the transient &#8220;entrainment&#8221; of the AVNRT by the non-sustained ventricular tachycardia&#46; During the latter&#44; the atrial cycle length accelerated to the VT cycle length and the narrow tachycardia resumed after the VT spontaneously stopped&#46; We suggest that similar information to that obtained during the ventricular entrainment of SVT could also be inferred from spontaneous transient entrainment of an AVNRT by a VT &#91;&#40;V<span class="elsevierStyleInf">VT</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>VSVT&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>TCL&#93;&#44; to the best of our knowledge never previously described&#46; This is in favor of an AVNRT rather than orthodromic tachycardia &#40;AVRT&#41; due to the long &#91;&#40;V<span class="elsevierStyleInf">VT</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>V<span class="elsevierStyleInf">SVT</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>TCL&#93; interval &#40;140ms-160ms&#41;&#44; similar to the PPI-TCL measurement&#44; which is also supported by the absence of atrial advancement by the spontaneous occurring PVC when the His bundle was refractory&#46; The VAV response also helps to rule out an atrial tachycardia&#46; In this regard&#44; during the VT runs and the subsequent SVT&#44; the first VA after the narrow QRS tachycardia was always fixed&#44; regardless of the different cycle lengths of the RVOT-VT&#44; another clue that helps to rule out an atrial tachycardia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D and E&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The fact that the syncope disappeared after ablation is interesting&#46; As is known&#44; syncope often has multiple contributory factors&#46; In the present case&#44; the high heart rate during orthostatism and a possible inadequacy of vascular compensation could have contributed to the syncope episodes&#46; However&#44; this is only supposition and the exact mechanism cannot be completely explained&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To summarize&#44; in such situations&#44; in which during tachycardia there is intermittent widening of the QRS&#44; care should be taken to not classify it as a simple transient aberrancy&#46; Subsequent analysis looking for clues pointing towards the presence of a double tachycardia should be taken into account&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human and animal subjects</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">Dr&#46; Mois&#233;s Rodr&#237;guez-Ma&#241;ero is funded by a post-residency grant on clinical electrophysiology from the European Society of Cardiology&#46;</p></span></span>"
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        "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We present the case of a 50-year-old patient with several episodes of syncope and documented simultaneous wide and narrow QRS complex tachycardia&#46; We then review this tacharrhythmia&#44; focusing on electrophysiological findings and pathophysiology&#44; diagnosis and treatment&#46;</p>"
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        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Apresentamos um caso de um doente de 50 anos com diversos epis&#243;dios de s&#237;ncope e documenta&#231;&#227;o de taquicardia com complexo QRS simultaneamente largo e estreito&#46; Fazemos uma revis&#227;o desta taquiarritmia tendo em especial aten&#231;&#227;o achados electrofisiol&#243;gicos e fisiopatologia&#44; diagn&#243;stico e tratamento&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Twelve-lead ECG&#46; In the first part of the tracing a broad QRS tachycardia is shown&#44; with LBBB inferior axis morphology and negative QRS complex in aVL&#46; After this run there is a change to a narrow QRS complex&#46; Surface leads &#40;I&#44; II&#44; III&#44; aVF&#44; V1 and V6&#41;&#44; and electrograms recorded from the right ventricular apex and the coronary sinus&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41;&#58; The long postpacing interval &#40;PPI-TCL&#62;180ms&#41; after tachycardia entrainment from the right ventricular apex and the tachycardia cycle length are shown&#59; &#40;B&#41;&#58; intracardiac recordings during the tachycardia&#46; The first two beats correspond to an AVNRT&#44; and the last three to the ventricular tachycardia&#46; Note the absence of His bundle deflection and variable retrograde conduction during the runs of broad complexes&#59; &#40;C&#41;&#58; absence of atrial advancement by spontaneous extrastimulus when the His bundle was refractory&#59; &#40;D and E&#41;&#58; transient entrainment of the AVNRT by the spontaneous non-sustained ventricular tachycardia is observed&#44; at different cycle lengths &#40;290 and 310ms respectively&#41;&#46; The long interval after the last beat of the broad QRS complex tachycardia and the first beat of the narrow QRS complex tachycardia can also be seen&#44; with VAV response and a fixed VA interval after the ventricular tachycardia &#40;see text&#41;&#46;</p>"
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
Dados atualizados diariamente
Ano/Mês Html Pdf Total
2024 Novembro 9 6 15
2024 Outubro 57 42 99
2024 Setembro 73 24 97
2024 Agosto 90 40 130
2024 Julho 51 33 84
2024 Junho 64 32 96
2024 Maio 75 38 113
2024 Abril 54 40 94
2024 Maro 59 31 90
2024 Fevereiro 54 21 75
2024 Janeiro 53 26 79
2023 Dezembro 49 22 71
2023 Novembro 70 43 113
2023 Outubro 53 14 67
2023 Setembro 62 19 81
2023 Agosto 46 24 70
2023 Julho 47 11 58
2023 Junho 40 16 56
2023 Maio 62 29 91
2023 Abril 42 8 50
2023 Maro 50 23 73
2023 Fevereiro 42 18 60
2023 Janeiro 34 13 47
2022 Dezembro 45 24 69
2022 Novembro 66 32 98
2022 Outubro 62 25 87
2022 Setembro 43 44 87
2022 Agosto 85 30 115
2022 Julho 79 44 123
2022 Junho 64 42 106
2022 Maio 65 34 99
2022 Abril 53 45 98
2022 Maro 65 51 116
2022 Fevereiro 65 35 100
2022 Janeiro 69 23 92
2021 Dezembro 51 42 93
2021 Novembro 56 40 96
2021 Outubro 74 48 122
2021 Setembro 56 29 85
2021 Agosto 51 41 92
2021 Julho 38 27 65
2021 Junho 53 25 78
2021 Maio 46 33 79
2021 Abril 102 63 165
2021 Maro 110 25 135
2021 Fevereiro 114 22 136
2021 Janeiro 80 23 103
2020 Dezembro 60 27 87
2020 Novembro 61 20 81
2020 Outubro 56 32 88
2020 Setembro 114 28 142
2020 Agosto 70 20 90
2020 Julho 75 23 98
2020 Junho 85 22 107
2020 Maio 70 14 84
2020 Abril 70 20 90
2020 Maro 96 25 121
2020 Fevereiro 207 50 257
2020 Janeiro 119 27 146
2019 Dezembro 105 15 120
2019 Novembro 90 8 98
2019 Outubro 92 6 98
2019 Setembro 176 27 203
2019 Agosto 81 14 95
2019 Julho 69 18 87
2019 Junho 95 22 117
2019 Maio 101 10 111
2019 Abril 69 17 86
2019 Maro 81 13 94
2019 Fevereiro 85 15 100
2019 Janeiro 101 17 118
2018 Dezembro 120 18 138
2018 Novembro 113 15 128
2018 Outubro 218 31 249
2018 Setembro 113 17 130
2018 Agosto 140 124 264
2018 Julho 69 8 77
2018 Junho 78 11 89
2018 Maio 93 18 111
2018 Abril 93 10 103
2018 Maro 104 10 114
2018 Fevereiro 59 5 64
2018 Janeiro 77 6 83
2017 Dezembro 106 12 118
2017 Novembro 74 7 81
2017 Outubro 44 8 52
2017 Setembro 62 10 72
2017 Agosto 56 25 81
2017 Julho 65 16 81
2017 Junho 62 17 79
2017 Maio 101 16 117
2017 Abril 52 8 60
2017 Maro 103 53 156
2017 Fevereiro 125 13 138
2017 Janeiro 31 6 37
2016 Dezembro 48 10 58
2016 Novembro 62 15 77
2016 Outubro 123 21 144
2016 Setembro 92 11 103
2016 Agosto 38 7 45
2016 Julho 35 14 49
2016 Junho 20 9 29
2016 Maio 1 10 11
2016 Abril 63 1 64
2016 Maro 78 13 91
2016 Fevereiro 74 22 96
2016 Janeiro 52 9 61
2015 Dezembro 79 12 91
2015 Novembro 77 8 85
2015 Outubro 117 21 138
2015 Setembro 79 10 89
2015 Agosto 90 12 102
2015 Julho 86 8 94
2015 Junho 65 3 68
2015 Maio 77 13 90
2015 Abril 103 11 114
2015 Maro 79 9 88
2015 Fevereiro 81 7 88
2015 Janeiro 51 8 59
2014 Dezembro 67 12 79
2014 Novembro 71 15 86
2014 Outubro 87 16 103
2014 Setembro 62 20 82
2014 Agosto 73 20 93
2014 Julho 61 9 70
2014 Junho 70 12 82
2014 Maio 61 11 72
2014 Abril 69 7 76
2014 Maro 91 18 109
2014 Fevereiro 110 17 127
2014 Janeiro 94 14 108
2013 Dezembro 108 20 128
2013 Novembro 99 13 112
2013 Outubro 81 17 98
2013 Setembro 88 20 108
2013 Agosto 95 20 115
2013 Julho 97 37 134
2013 Junho 55 35 90
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