AN INTERESTING CAUSE OF WIDE COMPLEX TACHYCARDIA: ASHMAN%26apos;S PHENOMENON IN ATRIAL FIBRILLATION

作者：Harrigan Richard A^*; Garg Manish

来源：Journal of Emergency Medicine, 2013, 45(6): 835-841.

DOI：10.1016/j.jemermed.2013.08.018

• Ashman%26apos
• s phenomenon
• atrial fibrillation
• aberrant conduction
• electrocardiogram
• right bundle branch block

Background: Ashman%26apos;s phenomenon is an aberrant intraventricular conduction abnormality that occurs in response to a change in QRS cycle length. In atrial fibrillation, Ashman%26apos;s phenomenon will present as a long RR cycle followed by a short RR cycle, with the subsequent QRS complex manifesting a right bundle branch block morphology. This morphologic variation can create difficulty with electrocardiographic interpretation, and can alter management in patients with this dysrhythmia. Objectives: This report presents a case, describes the Ashman%26apos;s phenomenon in atrial fibrillation, and discusses interpretation of this electrocardiographic finding. Case Report: This is a 27-year-old woman who presented with palpitations and chest pain. The patient was symptomatic with a heart rate %26gt;200 beats/min and a wide complex tachycardia on electrocardiogram. Conclusions: Ashman%26apos;s phenomenon should be suspected in atrial fibrillation when there is a long cycle followed by a short cycle, with the subsequent QRS complex manifesting a right bundle branch block pattern. Emergency physician awareness of this phenomenon may improve diagnostic certainty and have an impact on dysrhythmia management.

• 出版日期2013-12