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Year : 2016  |  Volume : 13  |  Issue : 1  |  Page : 90

Diagnosis of supraventricular tachycardia and Wolf-Parkinson-White syndrome

Division of Cardiology, Department of Internal Medicine, University of Maiduguri Teaching Hospital, University of Maiduguri, PMB. 1069, Maiduguri, Borno State, Nigeria

Date of Web Publication13-Jan-2016

Correspondence Address:
Mohammed Abdullahi Talle
Division of Cardiology, Department of Internal Medicine, University of Maiduguri Teaching Hospital/University of Maiduguri, PMB. 1069, Maiduguri, Borno State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0189-7969.173852

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How to cite this article:
Talle MA. Diagnosis of supraventricular tachycardia and Wolf-Parkinson-White syndrome. Nig J Cardiol 2016;13:90

How to cite this URL:
Talle MA. Diagnosis of supraventricular tachycardia and Wolf-Parkinson-White syndrome. Nig J Cardiol [serial online] 2016 [cited 2021 Jun 19];13:90. Available from: https://www.nigjcardiol.org/text.asp?2016/13/1/90/173852


The case of tachyarrhythmia in a neonate by Sadoh WE and Okonkwo IR published ahead of print is about the first of its kind in the country.[1] Assessment and management of fetal tachyarrhythmia remains a complex and challenging area of medicine.[2] To have successfully diagnosed while utero, and make a decision regarding the optimum mode of delivery and management is certainly commendable.

However, the diagnosis Wolf-Parkinson-White syndrome is not supported by the sets of electrocardiographys (ECGs) presented. The ECG in [Figure 1] is neither a preexcited supraventricular tachycardia (SVT), nor a sinus rhythm. It is depicting an atrial flutter with a 2:1 conduction. Careful analysis of the rhythm will reveal an atrial flutter rate of 428 per min (1500/3.5 = 428.5714) and a ventricular rate of 214 per min (1500/7 = 214.2857), in keeping with the 2:1 conduction. In a similar manner, analysis of the atrial flutter presented in [Figure 2] will reveal a rate of 428 (1500/3.5 = 428.5714) per min, exactly the rate observed in [Figure 1], suggesting that it is one and the same. A trick that can be helpful in assessing atrial flutter is to imagine that the QRS complexes aren't there. This may allow the background flutter waves to be better appreciated.{Figure 1}{Figure 2}

What appears as aPwave in [Figure 1] is actually the flutter wave and cannot be used in computing PR interval. The slurred upstroke to the QRS complex appearing like a delta wave is a result of an overlap between QRS complexes and flutter waves. [Figure 1] can only be possibly a preexcited SVT if it represents the antidromic type, a pattern observed in about 5% of cases. Atrial flutter conducting over an accessory pathway could result in tachycardia with wide preexcited QRS complexes. However, the conduction in such cases is 1:1. Giving adenosine in the case presented resulted in slowing of ventricular rate, thereby reducing the number of QRS complexes, and unmasking the background atrial flutter.

It is a common practice to use adenosine in differentiating atrial flutter from SVT as demonstrated here. Analyses of [Figure 1] and [Figure 2] reveal that the flutter rate (expectedly) remained the same pre- and post-adenosine. Tachyarrhythmia can result from the use of adenosine, with nonsustained monomorphic ventricular tachycardia and ventricular ectopy being the most common.[3] Atrial tachycardia including atrial fibrillation and atrial flutter may also be induced by adenosine. When used in the setting of atrial flutter, adenosine can cause a 1:1 conduction and hemodynamic compromise.

The analogy given above is purely based on information presented in the publication. Diagnosis and management of fetal tachyarrhythmia remains a daunting task, and the successful management of the case presented is admittedly a feat worthy of commendation.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Sadoh WE, Okonkwo IR. Supraventricular tachycardia in a neonate with Wolff-Parkinson-White syndrome. Niger J Cardiol 2015;12:151-3.  Back to cited text no. 1
Strasburger JF, Cuneo BF. Assessment and treatment of fetal arrhythmias. In: Saksena S, Camm AJ, editors. Electrophysiological Disorders of the Heart. 2nd ed. Philadelphia, PA: Elsevier/Saunders; 2012. p. 1027-42.  Back to cited text no. 2
Mallet ML. Proarrhythmic effects of adenosine: A review of the literature. Emerg Med J 2004;21:408-10.  Back to cited text no. 3


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