Case 142

Abstract

A 59 year old woman with severe rheumatoid arthritis developed recurrent episodes of a narrow complex tachycardia after an orthopedic surgical procedure. She had a history of recurrent supraventricular tachycardia that began at age 17 years. In 1991, at age 42, she had undergone an electrophysiologic study which showed dual AV nodal pathways and easily inducible typical (slow-fast) AV node reentrant tachycardia. She underwent a fast pathway ablation which resulted in a persistent first degree AV block (PR interval 240-340 ms) that was asymptomatic. Seven years after the first electrophysiologic study, she developed hyperthyroidism and in that setting had episodes of paroxysmal atrial fibrillation. She was treated with flecainide 50 mg bid and had only very rare spells of atrial fibrillation once her hyperthyroidism had been corrected. Recently, she had undergone back surgery to revise spinal hardware in place to correct scoliosis. After the procedure, she developed episodes of the tachycardia shown in Fig. 142.1. © Springer-Verlag London Limited 2011.