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Challenges in Clinical Electrocardiography
November 22, 2021

An Unusual Wide Complex Rhythm—What Is the Diagnosis?

Author Affiliations
  • 1Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning Province, China
  • 2Department of Cardiology of the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
JAMA Intern Med. 2022;182(1):72-73. doi:10.1001/jamainternmed.2021.6778

A woman in her 80s was referred for a cardiac evaluation after results from an electrocardiogram (ECG) performed during a routine health evaluation showed a wide QRS complex. The patient had no previous medical records with her at the evaluation. An initial 12-lead ECG is shown in the Figure, A.

Questions: On close examination of the admission ECG, what are the unusual findings, and what is the most appropriate next step in the evaluation? How should the ECG be further analyzed?

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