Case Report:
A 54-year-old man with no previous past medical history presented to his
primary care physician with a one-year history of progressive dyspnea on
exertion. On examination, he was found to have resting tachycardia with
a heart rate ranging from 150-180 bpm; physical examination was notable
for lower extremity edema and pulmonary rales. A transthoracic
echocardiogram revealed a severely reduced EF of 20% with significantly
elevated LA pressure. Multiple initial 12-lead ECGs (obtained within
hours of each other) demonstrated a narrow complex tachycardia, at times
with grouped beating (Figure 1A).
The patient was admitted to the hospital for suspected
tachycardia-induced cardiomyopathy and was treated with IV diuresis and
initiation of guideline-driven medical therapy for heart failure.
Following his admission, telemetry was interpreted as showing periods of
“ventricular bigeminy” (Figure 1B) and “ventricular couplets”
(Figure 1C). Heart rate trends showed incessant tachycardia (figure 1D).
Electrophysiology consultation recommended ablation, and the patient was
brought to the Electrophysiology (EP) laboratory.