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A 21-year-old woman presented to the emergency room with palpitations and lightheadedness. Her ECG at presentation showed broad complex tachycardia at 235 beats per minute with right bundle branch morphology, inferior rightward axis, and positive concordance in the precordial leads (Figure 1A).  tachycardia was terminated with electric cardioversion after adenosine had no effect.  subsequent ECG demonstrated sinus rhythm, PR interval 100 ms, a positive delta wave in leads V1, II, III, and aVF, isoelectric in lead I and negative in aVR (Figure 1B). Subsequent echocardiography demonstrated a structurally normal heart. She proceeded to an electrophysiological study.Figure 1. Surface ECGs of ( A ) presenting tachycardia and of ( B ) sinus rhythm after cardioversion.Editor’s Perspective see p 502 The baseline AH interval was 57 ms and HV was 13 ms. Atrial activation during ventricular pacing featured simultaneous activation of the lateral coronary sinus (CS) and septal (His) electrodes (not pictured). Programmed atrial extrastimuli reproducibly induced broad QRS complex tachycardia (Figure 1A). Attempts to entrain the tachycardia from the atrium induced atrial fibrillation that spontaneously terminated. Attempts to entrain tachycardia from the ventricle terminated tachycardia. Therefore, scanning sensed atrial extrastimuli during tachycardia were delivered …

Broad Complex Tachycardia Terminating With Atrial Premature Beats From 2 Different Sites