20-year old patient with sudden onset of palpitations. What does the rhythm strip demonstrate?

TOP 100 ECG QUIZ LITFL 017

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Top rhythm strip

  • Regular narrow complex tachycardia
  • Pseudo-R’ waves (retrograde P waves) are seen deforming the J point

Middle rhythm strip 

  • 12mg adenosine given
  • A salvo of broad and bizarre-looking complexes interrupts the rhythm (this is a common phenomenon during chemical cardioversion with adenosine)

Bottom rhythm strip

  • The patient has reverted to sinus rhythm
  • The pseudo-R’ waves have now disappeared
  • There are no obvious delta waves of WPW, but this should be confirmed on a 12-lead ECG

CLINICAL PEARLS

The 12-lead ECG confirms reversion to sinus rhythm and does not demonstrate any features of WPW. The diagnosis is AV-nodal reentry tachycardia (AVNRT).

Typical-AVNRT-resolved

TOP 100 ECG SERIES


Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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