Ventricular Tachycardia: A-V Dissociation
Report:
Ventricular tachycardia 150/min
A-V dissociation
Comment:
This is, again, a LBBB-like tachycardia with normal axis, in fact diagnosed by the computer as “LBBB”. This is obviously not the case in view of the slow and notched, laboured descent to the nadir of S wave in V1. Further, the V1 rhythm strip shows clear evidence of independent atrial activity, consistent with sinus P waves seen in the post-cardioversion trace below (Fig 4a). While A-V dissociation is not an absolute proof of the ventricular origin of the broad complexes4, it certainly supports it5.
Below is the patient’s sinus rhythm, with VEBs, again, as in Fig 3a, virtually identical to the VT.
The ICD was not much better than the ECG computer: it failed to detect this episode of VT – presumably it was too slow. Oddly enough, after the ICD was interrogated, its settings were left unchanged and the patient sent home – on more sotalol!
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