1. Wide QRS Tachycardia with Two
Different P Waves,
WHAT IS THE MECHANISM ?
Paul Wei Hua Tang, Kun Tai Lee, Wei Chung Tsai, Wen De Lai
Kaoshiung Medical University Hospital

2. Brief History
• 38 years old male without any systemic
disease or regular medication
• Complained of palpitation frequently during
past few months
• Tachycardia with stable vital sign during
palpitation at emergency room

4. Differential Diagnosis
• Multifocal atrial tachycardia with aberrant
conduction
• Ventricular tachycardia with AV dissociation
with frequent atrial premature complex
• Ventricular tachycardia with sinus P wave and
retrograde VA conduction P wave

6. Laboratory Data and Echo Data
• Normal electrolytes
• Normal cardiac echo findings No structural
heart disease

7. Tachycardia Surface EKG

8. Tachycardia Intracardiac Electrogram

9. • No antegrade or retrograde dual AV node
properties
• Ventricular electrical activity predominant
• Zero HV interval
Idiopathic Left Ventricular Tachycardia

10. Diastolic Potentials at Successful
Ablation Site

11. Thank You for Attention