Right Ventricular Outflow Tract Tachycardia

Report:

Ventricular tachycardia 165/min

Irregular

Non-sustained

Sinus tachycardia 125/min

Comment:

This is a fairly typical RVOT tachycardia, with marked right axis deviation (inferiorly directed, from the “roof” of the RV) and Rosenbaum pattern in V1 (small but thick initial R wave). Short runs are often quite irregular. The only differential diagnosis here would be type “B” pre-excited AF.

More of the same is shown below(Fig 172a).

This form of VT is often provoked by exercise or adrenergic stimuli, consistent with her observed sinus tachycardia. She was started on metoprolol and sent home.

A recent study suggests that frequent monomorphic VEBs and runs can cause a true cardiomyopathy in this setting, reversing the previous view that RVOT ectopic activity is almost always benign. Ablation reverses it128.

Sinus rhythm trace is shown in 172b.

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