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A 24-year-old woman was admitted with a 24 h history of palpitations and breathlessness. She had no previous history of chest pain, dizziness or syncope. She had previously undergone a heterotropic heart transplant 14 years ago owing to cardiac failure related to idiopathic dilated cardiomyopathy. A physical examination demonstrated a pulse of 160 bpm with prominent A wave in the jugular venous pulse. Her blood pressure was 98/50 mm Hg, and the apex beat was palpable on both sides of the chest, corresponding to the native and heterotropic transplanted hearts.
The 12-lead electrocardiogram fig 1 (panel A) showed a broad complex tachycardia with a right bundle branch block morphology at a rate of 210 bpm. However, a narrow complex QRS can be clearly identified (lead II) interposed between the broad complexes. Narrow complexes could result from capture, echo beats or be due to normal activation of the non-affected heart.1 Therefore a right-sided ECG was performed by repositioning the precordial leads on the right side of the chest. This right-sided ECG (panel B) showed more stable sinus rhythm in V4R to V6R and relatively smaller voltages of broad complexes which may be explained by the dextrocardiac position of the heterotropic transplanted heart. Her chest radiograph (panel C) also confirmed the site of the native and the donor heart in the chest. Furthermore, echocardiography also confirmed the tachycardia of the native heart.
Provenance and peer review Not commissioned; not externally peer reviewed.