{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:23:44Z","timestamp":1753878224720,"version":"3.41.2"},"reference-count":6,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:00:00Z","timestamp":1614211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Noninvasive Electrocardiol"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A 23\u2010year\u2010old woman with palpitations for 9\u00a0years was referred for catheter ablation. ECG showed an irregular narrow complex tachycardia with alternating and gradually changing QRS morphologies after alternating and changing RR intervals, with a clear pattern of 2 alternating QRS complexes. An electrophysiology study was performed and confirmed that the mechanism of tachycardia was an automatic left\u2010side His\u2010Purkinje system (HPS) ventricular tachycardia. The gradually changing type\u20102 QRS complexes was the conduction delayed in the left anterior fascicle due to the short RR interval or the short left\u2010side HH interval. Nine months after the index electrophysiology study, the patient encounter a progressive of heart failure with increased heart rate to 130\u2010150\u00a0bpm during rest. Radiofrequency ablation was performed at the upper\u2010septum for eliminating the tachycardia and resulted in complete atrioventricular block. A permanent pacemaker with left bundle branch pacing was implanted. Twelve months after the ablation, the enlarged heart shrink to normal with normal left ventricular ejection fraction. In conclusion, careful interpretation of the ECG can identify the sinus P waves followed by irregular narrow complexes, thus avoiding misdiagnosis and unnecessary treatment. Unifocal HPS tachycardia could present with alternating and gradually changing narrow QRS complexes tachycardia and lead to tachycardia cardiomyopathy. Electrophysiology study and catheter ablation were useful for the diagnosis and treatment of HPS tachycardia but with high risk of atrioventricular block. However, successfully elimination the tachycardia would resolve and reverse the enlarged heart and deteriorative heart function.<\/jats:p>","DOI":"10.1111\/anec.12836","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T08:12:59Z","timestamp":1614240779000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Alternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6492-5702","authenticated-orcid":false,"given":"Songwen","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Cardiology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shangai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feilong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology Fujian Medical University Union Hospital Fuzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Cardiology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shangai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7012-7061","authenticated-orcid":false,"given":"Xiaofeng","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Cardiology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shangai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Genqing","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardiology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shangai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0351-6868","authenticated-orcid":false,"given":"Shaowen","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shangai China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,2,25]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.119.008173"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.039165"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2015.193"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2018.06.015"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540\u20108159.2011.03044.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2019.05.007"}],"container-title":["Annals of Noninvasive Electrocardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anec.12836","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/anec.12836","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anec.12836","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T12:02:58Z","timestamp":1693224178000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/anec.12836"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,25]]},"references-count":6,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1111\/anec.12836"],"URL":"https:\/\/doi.org\/10.1111\/anec.12836","archive":["Portico"],"relation":{},"ISSN":["1082-720X","1542-474X"],"issn-type":[{"type":"print","value":"1082-720X"},{"type":"electronic","value":"1542-474X"}],"subject":[],"published":{"date-parts":[[2021,2,25]]},"assertion":[{"value":"2021-01-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e12836"}}