Multiform & Monomorphic Ventricular Tachycardia

Report:

Multiform ventricular tachycardia 180-210/min

Comment:

The tachycardia becomes (or looks) uniform in some leads, as is often the case in both torsades de pointes and other types of multiform ventricular tachycardia. It starts with what Marriott aptly calls the swinging pattern, itself a strong proof of ectopic ventricular origin. Of course, different-looking complexes in VT may be due to fusion (Dressler) beats – but not next to each other, at the rate of the tachycardia. It then settles for uniform beating.

In lead V1, the slow descent of the S wave is typical of VT.

The patient had no evidence of QT prolongation or other predisposition to torsades; she almost certainly had multiform VT on the basis of ischæmic heart disease. Her sinus rhythm ECG is shown below (Fig 102a), with probable old inferior MI, LVH and non-specific ST/T changes.

Innumerable episodes responded poorly to xylocaine, magnesium and amiodarone and she required adrenaline to maintain her (sinus rhythm) cardiac output; eventually she was intubated and transferred from CCU to ICU. There she stabilised on procainamide infusion and was transferred to Sydney for EPS and surgery. Unfortunately, further arrests en route resulted in cardiogenic shock; she had coronary angiography and two CABGs, continuing to arrest in VT postoperatively until her death the following day.

Fig 102b is another of her VTs, not really distinguishable from RBBB/LAHB aberrancy with septal infarction (QR instead of RSR’ in V1) but for the numerous fusion beats. Note that the rhythm strip is not synchronous with the 12-lead trace above.