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Challenges in Clinical Electrocardiography
July 2018

A Near-Disaster in Rescuing Wide Complex Tachycardia—Can We Always Trust External Defibrillators?

Author Affiliations
  • 1Graduate student at Mercer University School of Medicine, Macon, Georgia
  • 2Blackpool Victoria Hospital, Blackpool, England
  • 3Centennial Heart, Southern Hills Medical Center, Nashville, Tennessee
JAMA Intern Med. 2018;178(7):980-981. doi:10.1001/jamainternmed.2018.1962

A man in his 50s arrived at a fast-food restaurant feeling dizzy and experiencing shortness of breath. Emergency medical services were called. On their arrival, the patient was found conscious but diaphoretic with a blood pressure of 96/67 mm Hg and a heart rate of 190 bpm. His initial electrocardiogram (ECG) showed a fast, regular, wide QRS complex tachycardia (WQRST) (Figure 1). Intravenous lidocaine was given without effect; consequently, electrical cardioversion was pursued. An initial synchronized shock of 100 J was delivered; however, this did not terminate the tachycardia. Instead, the rhythm deteriorated into ventricular fibrillation (VF) (Figure 2). Subsequently, 4 more shocks with escalating energy were delivered but failed to convert him to sinus rhythm. Eventually, a final shock of 360 J was successful to establish normal sinus rhythm with transient AV block, which resolved spontaneously (eFigure 1 in the Supplement).

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