VT Triplet in AF with Rapid Ventricular Response
Report:
Atrial fibrillation with rapid ventricular response 147/min
Triplet of ventricular tachycardia
Right axis deviation +120o
Possible old anteroseptal infarct
Possible LVH with ST/T changes (RV6 > RV5)
Comment:
The three RR’ complexes are too late to be aberrant; furthermore, there is an attempt at a “pause” – even though this is atrial fibrillation. Aberrantly conducted complexes in AF usually have no such pause.
Three or more VEBs at a rate over 100/min are sufficient for the diagnosis of VT22.
The presence of this triplet does not have much clinical significance and does not merit separate treatment. It would be tempting to say that this ventricular ectopic activity may be tempered by treating the atrial fibrillation – reducing the unfavourable hæmodynamics and potential ischæmia, etc. Or, better still, addressing the cause of atrial fibrillation – heart failure, thyrotoxicosis, sepsis, etc. This is logical, but does not always work: VEBs in some patients persist regardless of any other factors, as the trigeminy below (Fig 19a) demonstrates. This patient had the same species of VEBs for years.
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