Abstract
Background: Supraventricular tachycardia is the commonest type of narrow complex regular tachycardia seen in an emergency room, which can easily be diagnosed by surface ECG and acutely managed by Adenosine injection. A 59 years old male smoker was presented with palpitation with a pulse rate of 220/min with mild hemodynamic compromise. ECG confirmed narrow complex regular tachycardia, and the initial working diagnosis was established as Supraventricular Tachycardia (SVT) in the emergency room.
Case Presentation: As standard practice, adenosine was given, which failed in terminating the tachycardia but by creating a transient atrioventricular block, slowed down ventricular rate, and sawtooth-shaped P waves of atrial flutter were exposed. In contrast to the expectations, in this case of narrow complex regular tachycardia of supraventricular origin, adenosine could not establish the sinus rhythm but confirmed the diagnosis of atrial flutter with the regular rate with fixed A-V block.
Conclusion: Instead of therapeutic use, adenosine has been proven to be of diagnostic value, which can be used when the diagnosis of narrow complex tachycardia is in doubt, however with some cautions.
Keywords: Adenosine, Atrial flutter, Supraventricular tachycardia, Narrow complex tachycardia, Atrioventricular block, ECG.
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