Good Torsade, Wrong Components
Report:
Sinus tachycardia 112/min
Left bundle branch block
Ventricular tachycardia 118/min
Ventricular fusion beats
Probable 1:1 retrograde conduction
Junctional escape beats (bottom)
Comment:
The two panels are almost identical and one has to compare them beat by beat to establish it was not the same strip replayed from the computer’s memory.
The “torsade” in the middle of the upper strips is a series of fusion beats with incremental ventricular ectopic contribution. It looks like a torsade de pointes, but isn’t. That’s the “twist” here.
The VT establishes retrograde conduction toward the end of the upper strips, maintaining it until its termination. The sinus rhythm is subject to a degree of overdrive suppression and captures the ventricles after three dissociated junctional escape beats in both lower strips.
The VT is relatively slow, while the sinus rhythm is fast; some authors would designate this VT as AIVR.
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