Multiform Ventricular Tachycardia

Report:

Atrial fibrillation

Runs of multiform ventricular tachycardia 150 – 180/min

Right axis deviation +165o

Probable right bundle branch block

Acute inferior infarction

Comment:

There are only four pure supraventricular beats to be seen – two before and two after the short VT run at the beginning of the recording. They look bizarre enough in their own right, with deep broad S waves in leads 1 and aVL and ST segment shifts rounded into the ensuing T waves: they would suggest ventricular ectopic origin were it not for their even more bizarre and faster neighbours.

The next trace (Fig 226a), 15 minutes later, has only four VEBs and the diagnosis of RBBB can be made more securely. There are massive reciprocal changes in the chest leads, implying a large infarction; the RBBB itself suggests RV involvement.

The patient had a large obtuse marginal branch of the LCX stented, with surprisingly good ECG result on the tracing obtained 6 hours later in ICU. He had VF during the procedure and was intubated and ventilated for 24 hours – probably the best strategy for most arrests.