Sudden Death During Holter Monitoring

Report:

Top:

Sinus rhythm

Dimorphic VEB couplet

Middle:

Deepening T wave inversion

VEB

R-on-T VEB following post-ectopic pause

Ventricular tachycardia 187/min following R-on-T VEB

Bottom (after carotid sinus massage):

Ventricular tachycardia 212/min

Comment:

This unfortunate man’s 12-lead ECG in VT and in sinus rhythm are shown on the next page (Fig 203a, 203b). The north-west axis, RV1 and QSV6 are diagnostic of VT - there was no need to perform the fatal massage!

The R-on-T phenomenon is, obviously, propitiated by the long preceding cycle created by the VEB139.

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