The ECG revealed a regular wide complex tachycardia at a rate of 104 bpm (Figure 1). P waves were evident in leads V2 and V3 with 1:1 atrioventricular association. There was no response to carotid sinus massage. The QRS complex had a broad slurred sinusoidal pattern such that there was difficulty separating depolarization (the QRS complex) from repolarization (the ST segment and T wave).
Phenytoin and fluconazole were discontinued, while hemodialysis was continued in the intensive care unit. The ECGs were repeated (Figure 2 and Figure 3), while corrected phenytoin levels declined. Forty-eight hours after discontinuation of phenytoin and fluconazole treatment, the patient's ECG returned to baseline. Cardiac troponin levels remained normal throughout this period.
Bizarre and Wide QRS After Liver Transplant—Diagnosis. JAMA Intern Med. 2013;173(11):954–955. doi:10.1001/jamainternmed.2013.644b
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