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A challenging broad-complex tachycardia
  1. Nithin Ramesh Iyer1,
  2. Adrianus W G J Oomen1,
  3. Raymond W Sy1,2
  1. 1 Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  2. 2 Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Nithin Ramesh Iyer, Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; nithin.iyer{at}


A 53-year-old man presented with chest pain, palpitations and presyncope, without history of overt cardiac disease. The patient was alert. His heart rate was 206 beats per minute, and his blood pressure was 100/50 mm Hg. An intravenous bolus of amiodarone 150 mg was administered in the emergency department. His ECGs preamiodarone and postamiodarone are shown in figure 1. Echocardiography showed low-normal left ventricular systolic function.

Figure 1

(A) ECG of index arrhythmia. (B) ECG following amiodarone.

Question What should the next diagnostic test be?

  1. Referral for electrophysiology study.

  2. Referral for urgent coronary angiography.

  3. 12-lead ECG with posterior lead placement.

  4. Bedside adenosine challenge.

  • Broad complex tachycardia
  • adenosine
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  • Contributors NRI, AWGJO and RWS designed the image challenge vignette, question and answer. NRI and RWS drafted the article. NRI, AWGJO and RWS critically revised the article. NRI and RWS revised the article in response to reviewer comments. NRI, AWGJO and RWS provided final approval of the version to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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