case_images: PMC8616676_01
case_images: Twelve-lead electrocardiogram showing ventricular fibrillation. A biphasic shock of 200 J was applied with conversion to a regular wide complex tachycardia with a heart rate of 215 bpm.
case_images: CRIC2021-9083144.001.jpg
case_images: PMC8616676_01_CRIC2021-9083144.001.jpg
case_images: fig1
case_images: When the prehospital critical care team arrived, the cardiac rhythm was ventricular fibrillation (VF) and a biphasic shock of 200 J was applied with conversion to a regular wide complex tachycardia with a heart rate of 215 bpm (Figure 1).
case_images: Twelve-lead electrocardiogram showing atrial fibrillation with a rapid preexcited ventricular response. Irregular RR intervals, wide QRS complexes with varying QRS width, and initial delta wave (arrow). The shortest preexcited RR interval is nearly 300 ms.
case_images: CRIC2021-9083144.002.jpg
case_images: PMC8616676_01_CRIC2021-9083144.002.jpg
case_images: fig2
case_images: During the transport to the hospital, the patient became unstable again presenting irregular wide complex tachycardia suggestive of preexcited atrial fibrillation (AF) and a synchronized shock was applied (Figure 2).
case_images: Twelve-lead electrocardiogram after conversion to sinus rhythm (=baseline electrocardiogram). Shortened PR interval, delta wave, and secondary repolarization abnormalities are seen. This ECG is indicative of WPW syndrome, and a left anterolateral AP is suggested by negative QRS in V1 lead, QS complex in aVL lead, and positive delta wave in V3-V6 leads and inferior leads.
case_images: CRIC2021-9083144.003.jpg
case_images: PMC8616676_01_CRIC2021-9083144.003.jpg
case_images: fig3
case_images: However, 12-lead electrocardiogram (ECG) was compatible with sinus rhythm and ventricular preexcitation with shortened PR interval, delta waves in V3-V6 and inferior leads, and secondary ventricular repolarization abnormalities (Figure 3).