This ECG was donated to the ECG Guru by Dr. Arnel Carmona, one of our favorite Gurus. You will not often see such a great example of this. We are very grateful to Dr. Carmona for his contribution to learning. Dr. Carmona's new blog is EZG - ECG for beginners and enthusiasts.
An adult patient was admitted due to palpitations. What is this rhythm?This is a tachyarrhythmia that initially is regular wide complex (RBB morphology) and later became regular narrow complex at a rate of about 187 bpm. There is normalization of the QRS without a change in heart rate. In the latter part of the tracing (narrow complex), pseudo-r can be seen in V1. So, this is SVT with aberrancy with spontaneous normalization.
What is the cause of the intraventricular aberration during acceleration of heart rate? It could be due to failure of the refractory period to shorten or possible lengthening in response to acceleration.
What is the cause of the normalization of the of the QRS? The normalization of intraventricular conduction could be due to the gradual shortening of bundle branch refractory period in response to the tachycardia.
What is the possible mechanism maintaining the aberration? It is likely due to the transeptal concealed conduction blocking conduction in the contralateral bundle. With dissipation of transeptal conduction, the QRS complex normalizes.
What happened to the case? Adenosine was given, terminating the arrhythmia.
Fisch C. 1983. Aberration : Seventy-five years after Sir Thomas Lewis. BHJ 50:297-302
Fisch C and Knoebel SB. 2000. Electrocardiography of Clinical Arrhythmia. New York. Futura Publishing Co