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A 49-year-old man with a bicuspid aortic valve with severe stenosis and moderately depressed left ventricular ejection fraction underwent implantation of a mechanical aortic prosthesis. During the pre-operative evaluation, the electrocardiogram (ECG) showed sinus rhythm with first-degree atrioventricular block and voltage criteria of left ventricular hypertrophy (Fig. 1).
ECG during pre-operative evaluation
On the fourth postoperative day, the patient complained of sudden onset of rapid palpitations. The ECG is shown in Fig. 2. Both carotid sinus massage and a rapid intravenous bolus of 20 mg adenosine did neither temporarily slow down nor stop the tachycardia. Meanwhile, his blood pressure had declined to 70/40 mm Hg. A few minutes later, the patient lost consciousness and underwent immediate direct-current (DC) cardioversion. What is your diagnosis?
ECG during rapid palpitations
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Crooijmans, C., Rademakers, L.M. Syncope after aortic valve surgery. Neth Heart J 28, 219–222 (2020). https://doi.org/10.1007/s12471-019-1242-5
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DOI: https://doi.org/10.1007/s12471-019-1242-5