Picture Quiz Answer: A young man with palpitations

Answers 1. ECG No 1 (Figure 1) shows a broad complex irregularly irregular rythum which is consistent with atrial f ibrillation. The ventricular rate is very rapid and there is slow upstroke of R wave in the chest leads indicative of pre-excitation 2. DC Cardioversion is a safe option. In this patient DC Cardioversion was chosen due to the worrying rapid ventricular rate and risk of degeneration into ventricular f ibrillation (VF). Amiodrone in this situation can act as an atrio-ventricular (AV) node blocking agent and lead to unopposed AV conduction and risk of VF. 3. ECG No 2 (Figure 2) shows classical features of pre-excitation with short PR interval and delta wave in leads V2-V6; this is suggestive of the Wolff Parkinson White (WPW) syndrome. 4. Radiofrequency ablation of the accessory pathway is the treatment of choice Picture Quiz Answer: A young man with palpitations