Non-Sustained Right Ventricular Outflow Tract Tachycardia

Report:

Sinus tachycardia 110/min

Triplets of ventricular tachycardia 180/min

Borderline right atrial abnormality (RAA)

Comment:

This patient was ventilated for unexplained respiratory failure, thought to be vasculitis masquerading as asthma. She had moderate pulmonary hypertension and the runs of RVOT tachycardia were probably a reflection of her cor pulmonale. Interestingly, in lead V1 the complexes have a typical LBBB morphology, with sharp downstroke and delayed upstroke. Their ventricular origin is proven by the right axis deviation in the frontal plane – a feature not reported so far in aberrant conduction7. Another sample of the same VEBs, now as couplets, is shown below (Fig 15a).

Reader, this patient had a normal lung biopsy and died in multi-organ failure from complications of liver biopsy (liver was only congested, from cor pulmonale). The autopsy failed to show any significant (primary) lung pathology! I would not have believed this had I not been there throughout her ICU stay.

So what was it? Pulmonary emboli, recanalised? Pulmonary hypertension without appropriate histology? Mistaken pathology? I’ll never know.