ATRIAL FIBRILLATION AND HEMODINAMICALY UNSTABLE WIDE QRS COMPLEX TACHYCARDIA – A case report

Autori:

Mislav Puljević, Vedran Velagić, Borka Pezo-Nikolić, Davor Puljević

Sažetak

Tahikardija je aritmija karakterizirana srčanom frekvencijom > 100/minuti. Prema širini QRS-kompleksa može se podijeliti na tahikardije uskih (< 120 ms) i tahikardije širokih QRS-kompleksa (> 120 ms). Tahikardija uskih QRS-kompleksa uvijek je supraventrikularna, što znači da joj je izvorište proksimalno od Hisova snopa, dok tahikardija širokih QRS-kompleksa može biti ventrikularna (izvorište u ventrikulu distalno od Hisova snopa), ali i supraventrikularna. Strategija liječenja ovih dvaju poremećaja različita je pa je točna dijagnoza preduvjet optimalne terapije. Prikazujemo ovaj slučaj jer su diferencijalna dijagnoza tahikardije širokih QRS-kompleksa, a time i planiranje terapije bili posebno otežani zbog istodobno prisutne fibrilacije atrija te hemodinamske kompromitacije i akutnog ugrožavanja života bolesnice.

Summary

Tachycardia is an arrhythmia characterized by heart rate > 100 / minute. According to the width of the QRS complex it can be divided into narrow QRS (< 120 ms) and wide QRS tachycardia (> 120 ms). Narrow QRS tachycardia is always supraventricular which means that its source is proximal to the bundle of His, while wide QRS tachycardia can be ventricular (source is in the ventricle, distal to the bundle of His) or supraventricular. The strategies for treating these two conditions are different so the correct diagnosis is prerequisite for optimal therapy. We present this case because the differential diagnosis of wide QRS tachycardia and therefore the treatment planning was particularly difficult due to concurrently present atrial fibrillation with hemodynamic compromise and an acute threat to the life of the patient.