Ventricular Tachycardia or Atrial Flutter?

Report:

Ventricular tachycardia 250/min

Comment:

The trace is bizarre enough to qualify for VT; the marked respiratory swing in some leads gives it a multiform appearance. The rate, however, remains uniform and simultaneous leads confirm the basically uniform morphology. This is, insofar as one can tell, a LBBB-like ventricular tachycardia.

The problem here arose from discovery of underlying atrial flutter after amiodarone-induced putative cardioversion (Fig 46a). The flutter rate is slower, but it could be due to amiodarone effect. The QRS now shows a bizarre conduction defect – bizarre, but not too different from the one seen in the original tachycardia. The Northwest axis is still there in the frontal leads. The echocardiogram showed mild but definite left- and right-sided hypokinesia. A biopsy was consistent with arrhythmogenic right ventricular dysplasia and EPS showed inducible VT. An ICD was implanted and sinus rhythm restored.

In retrospect, the original diagnosis of VT could have been right. Both it and the flutter are related to cardiomyopathy. The ARVD can at times affect the left heart as well.