A previously healthy man in his 40s presented with sudden-onset palpitation that had been going on for more than an hour. He experienced similar symptoms in the past, but up to the current presentation, they were limited to a few minutes and only occurred with activity. He did not have any significant medical history or family history of cardiac disorders. He only took over-the-counter supplements and denied recreational substance use. On examination, he appeared comfortable. His heart rate was 224 beats per minute and his blood pressure was 123/97 mm Hg, with an oxygen saturation of 98% on room air. A 12-lead electrocardiogram (ECG) demonstrated a fast regular wide QRS complex tachycardia (Figure, A). He was given 150 mg of intravenous amiodarone with conversion to normal sinus rhythm within 10 minutes. Repeated ECG showed sinus rhythm with right bundle branch block and left anterior fascicular block (Figure, B). There were no prior ECGs available for comparison. He was started on oral amiodarone and was admitted to the cardiac intensive care unit for close monitoring.
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Liauw D, Dang A, Littmann L. Wide QRS Complex Tachycardia in an Apparently Healthy Man. JAMA Intern Med. Published online January 13, 2020. doi:10.1001/jamainternmed.2019.6694
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