VT: R in V1: Sharp Upstroke and Slurred Descent
Report:
Ventricular tachycardia 186/min
Comment:
The qR in V1 (and V2) has a sharp ascent and slower descent, an equivalent of the rabbit-ear sign of VT112. In the frontal plane, the QRS axis is in no-man’s land at about +260o. There is little reason to doubt the diagnosis of VT, apart from a vague resemblance to RBBB with LAHB. There was no response to adenosine.
The post-cardioversion trace shows marked post-tachycardia T wave inversion (125a), which later resolved, at least partially. Some of it could of course have been due to myocarditis itself. An echocardiogram showed mildly hypokinetic left ventricle. The troponin levels remained normal and a coronary angiogram showed normal arteries.
The same VT recurred month later 6 days after the patient stopped taking sotalol.
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