Shifting Rabbit Ears in VT

Report:

Ventricular tachycardia 152/min

Possible old anterior infarction

Comment:

There is a monophasic R, possibly a qR, in V1, with northwest axis in the standard leads and QSs in V5-6. The patient in fact had an old anterior MI (Fig 106a below, in AF, with LAHB + IVCD).

The rabbit ears in V1 are interesting: they seem to vary from beat to beat, presumably with respiration. The computer-stored (digitalised) ECGs are not ideal for finer details of morphology, tending to look as though composed of Lego bricks (which they are, magnified on a screen). One cannot fight “progress”, anyway. Very small rabbit ears are of course more likely to shift their disposition.

The implanted cardioverter-defibrillator failed to perform because its detection rate was set at 190/min; resetting the rate fixed the problem of recurrent VT for a short time, but then the patient had to return for EPS with more VT. Amiodarone and metoprolol failed, but sotalol appeared successful.

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