[Skip to Content]
[Skip to Content Landing]
Views 31
Citations 0
Comment & Response
December 2019

Additional Questions Regarding Wide QRS Tachycardia and Atrial Fibrillation—Reply

Author Affiliations
  • 1University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 2University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA Intern Med. 2019;179(12):1731-1732. doi:10.1001/jamainternmed.2019.5126

In Reply We appreciate the thoughtful review and appraisal from Xu and colleagues regarding the case report in our article.1

A question was raised if the rhythm in Figure 2 is consistent with sinus rhythm with an artifact. We appreciate the careful evaluation and suggestion of apparent P wave–like deflection before the QRS complexes. Another point noted was the relative regularity of the RR interval without an irregularly irregular QRS rhythm. Although it is challenging to appreciate a clear P wave in the majority of the leads, it seems apparent that lead II shows a consistent deflection that could be a P wave with apparent first-degree atrioventricular (AV) block. However, the proximity of the preceding T wave to the next P wave limits the evaluation in Figure 2. The corresponding deflection in lead V1 shows a negative axis, inconsistent with sinus P-wave morphology. In summary, the electrocardiogram could be defined as showing an atrial rhythm with variable PP interval leading to variable RR interval as compared with atrial fibrillation. We would like to draw the attention of the readers to the conducted QRS morphology in Figure 2 with bifascicular block and compare it with the wide QRS tachycardia morphology.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×