Repetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations
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摘要:
A 61-year-old female patient suffering from recent onset palpitations and dyspnea on exertion with hypertension and mitral valve prolapse in her past history came to our outpatient department.Echocardiography revealed a mild mitral valve prolapse,slightly decreased left ventricular (LV) function (LV ejection fraction:51%) and a mild mitral regurgitation.Initial 12-lead ECG showed normal sinus rhythm (NSR)with left anterior hemiblock,upper normal limit (105-110 ms) QRS duration and left atrial abnormality (not shown).24 hour ambulatory ECG monitoring (Figure 1) revealed a great variety of narrow QRS complex arrhythmias at first glance looking like sinus beats alternating either with aberrantly conducted atrial premature beats with hidden low amplitude P waves (Figure 1 first three rhythm strips) or with ventricular premature beats (Figure 1 upper rhythm strip) arranged in a bigeminal pattern.The third rhythm strip of Figure 1 may also be considered a narrow QRS complex tachycardia with alternating shorter and longer cycle lengths (CL) and the fourth rhythm strip of Figure 1 is a completely regular narrow QRS complex tachycardia with alternating narrow QRS complexes of slightly different morphology.