Non-Sustained Multiform Ventricular Tachycardia

Report:

Atrial fibrillation with rapid response

Intraventricular conduction delay (IVCD), probably left bundle branch block

Two runs of multiform ventricular tachycardia, approx. 250/min

Sinus rhythm, SVEBs and runs of atrial tachycardia (bottom strip)

Comment:

The longer VT run, in the top strip, imperceptibly changes its axis, in the manner of torsade de pointes; but the latter diagnosis cannot be made on the morphology of the VT alone.

Midway through the bottom strip, the rhythm changes to sinus rhythm - at least to the presumption of sinus rhythm, as only single sinus P waves are seen through the premature atrial complexes.

The patient was treated by amiodarone (sotalol was contraindicated in the setting of profound cardiac failure), with good control of the arrhythmias. She died in cardiogenic shock nevertheless. Prognostically, AF is worse than VT in this setting: it implies “power failure” rather than mere electrical instability.

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