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March 31, 2026Journal of Electrocardiology0 citations

Case report: An irregular wide QRS rhythm with flutter waves and a positive precordial concordance

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QRQiang RenYLYi LiuXPXiaobo Pu

Key Result

Amiodarone successfully resolved ventricular tachycardia in a patient presenting with an irregular wide QRS tachycardia initially misdiagnosed as atrial flutter with an accessory pathway.

Key Points

  • This case report aims to illustrate the difficulties in diagnosing wide QRS tachycardias and emphasize the importance of QRS morphology assessment.
  • A 69-year-old woman with a history of myocardial infarction experienced irregular wide QRS tachycardia.
  • ECG analysis identified positive precordial concordance and flutter waves, initially misinterpreted as atrial flutter.
  • Direct current cardioversion and administration of amiodarone were utilized to treat the observed tachycardia.
  • Initial misdiagnosis as atrial flutter was corrected to ventricular tachycardia after cardioversion was unsuccessful.
  • Amiodarone successfully resolved the ventricular tachycardia.
  • The case underscores the necessity of analyzing QRS morphology and AV relationships for accurate diagnosis.

Study Design

Type

Case Report (n=1)

Structured PICO

P
Population
69-year-old woman with persistent palpitation and a history of myocardial infarction (n=1)
I
Intervention
Direct current cardioversion followed by amiodarone
O
Outcome
Resolution of ventricular tachycardia

This case highlights the challenge of differentiating wide QRS tachycardias and emphasizes the importance of analyzing QRS morphology and atrioventricular relationship for accurate diagnosis.

Abstract

We report a 69-year-old woman with persistent palpitation, a history of myocardial infarction. ECG showed irregular wide QRS tachycardia with positive precordial concordance and flutter waves, initially misdiagnosed as atrial flutter with accessory pathway. Direct current cardioversion restored sinus rhythm but failed to terminate tachycardia, revealing ventricular tachycardia (VT). Amiodarone resolved VT. This case highlights the challenge of differentiating wide QRS tachycardias, emphasizing QRS morphology and atrioventricular (AV) relationship analysis for accurate diagnosis.

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Cite This Study

Ren et al. (2026) conducted a case report in Ventricular tachycardia (n=1). Direct current cardioversion and Amiodarone was evaluated. Amiodarone successfully resolved ventricular tachycardia in a patient presenting with an irregular wide QRS tachycardia initially misdiagnosed as atrial flutter with an accessory pathway.

synapsesocial.com/papers/6a025c97edf6f481385947behttps://doi.org/10.1016/j.jelectrocard.2026.154228
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