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A 50-year-old woman without a prior medical history was referred to the emergency room by a general practitioner because of palpitations. Two hours before, the patient had experienced her heart suddenly beating faster, but was otherwise feeling well. She was not using any medicine and denied substance abuse. Physical examination did not reveal any abnormalities except for a high pulse frequency. The ECG in Fig. 1 was recorded while performing carotid sinus massage.
ECG during carotid sinus massage
Questions
1. What is the most likely diagnosis of the tachycardia?
2. What is the likely origin of the eighth QRS complex?
3. What is the potential explanation for the morphology of the ninth QRS complex?
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Henkens, I., Zeppenfeld, K. & Hauer, A. Carotid sinus massage for diagnosis in narrow QRS tachycardia. Neth Heart J 23, 450 (2015). https://doi.org/10.1007/s12471-015-0731-4
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DOI: https://doi.org/10.1007/s12471-015-0731-4