Abstract
A 74-year-old woman with a history of persistent atrial fibrillation, hypertension, and hyperlipidemia presented to the emergency department (ED) after 3 days of intermittent palpitations and presyncope. She had been treated for atrial fibrillation with flecainide (150 mg twice daily) and metoprolol succinate (25 mg daily) for more than 20 years. In the ED, her heart rate was 150 bpm, and her blood pressure was 102/87. The electrocardiogram (ECG) is shown in Figure 1. The ECG obtained after a 150-mg bolus of intravenous amiodarone followed by a 200-J biphasic direct current shock is shown in Figure 2A . The ECG recorded soon after administration of 100 mEq of hypertonic sodium bicarbonate is shown in Figure 2B. What is the most likely cause of the wide complex tachycardia (WCT)? Figure 2A: Electrocardiogram with normal sinus rhythm and prolonged PR, QRS, and corrected QT intervals following direct current cardioversion. B: Electrocardiogram after treatment. View Large Image Figure Viewer Download Hi-res image
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