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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.

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