LBBB-Like VT in Patient with LBBB

Report:

Ventricular tachycardia 125/min

1:1 retrograde conduction

Spontaneous termination

Sinus rhythm

VEBs, one couplet

Comment:

The QS complexes in V1 take a very long time to reach the S wave nadir; the upstroke is quite sharp. This is the only reliable sign that they are ectopic ventricular in origin. Below (Fig 17a), the patient is in sinus rhythm and the comparison between his usual LBBB and the VEBs of the same morphology as the VT can be made in several leads. Both have the same duration – 0.16”, although the ectopics look more slender in some leads.

The tracings are a good example of how next to useless lead 2 in for intraventricular conduction, a point eloquently made by Marriott21.

This patient was one of many ventilated in terminal respiratory failure from fibrosing alveolitis, in what is closer to ritual than therapy.

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