Fascicular Ventricular Tachycardia & Positive Concordant Precordial Pattern

Report:

Ventricular tachycardia 198/min

Comment:

This VT is usually responsive to verapamil or adenosine; it is sometimes called Belhassen tachycardia, at least by Belhassen himself and his friends and family14.

The sinus rhythm trace contains five VEBs with marked left axis deviation, also retaining basic RBBB configuration, but with different precordial pattern. These, too, may have fascicular provenance. The first three show retrograde conduction, the last two are dissociated from sinus P waves. This does not affect the constancy of their inter-ectopic distances or the difference in their coupling intervals: parasystole!

The third supraventricular beat is a junctional one, seemingly “forced” (perhaps “facilitated” is a better term) by the preceding VEB with retrograde conduction (its P wave in V1 is down-up rather than up-down).

Less disturbed sinus rhythm is seen in Fig 11b.

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