(FIT)-Module 4 Workshop 7: Electrocradiogrpahic and Electrophysiological Correlations, Atrial Fibrillation, Clinical Scenarios and Syndromes-Poole Case 3 Answer

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Video Summary

The patient has a narrow complex regular tachycardia, likely AVNRT or AVRT. After adenosine, the irregular R to R intervals and variable QRS suggest pre-excited atrial fibrillation. For stable patients, IV procainamide or ibutylide is recommended, while unstable patients require DC cardioversion. The patient is hemodynamically stable, but sedation is concerning due to recent food and drink intake. AV nodal blocking agents, including non-dihydropyridine calcium channel blockers, digoxin, and IV amiodarone, should be avoided as they may worsen accessory pathway conduction. The best treatment choice is the least invasive and disruptive option.

Keywords

narrow complex tachycardia

AVNRT

AVRT

pre-excited atrial fibrillation

procainamide