Tachycardie Préfibrillatoire

Report:

Ventricular tachycardia, multiform > 300/min

?Torsade de pointes

?Ventricular flutter

Sinus rhythm

VEBs ? aberrant(RBBB) junctional premature beats

R-on-T phenomenon

Comment:

This is the fastest spontaneously terminating VT I have seen so far. Some of the speed would have been attributable to adrenaline 10 μg/min and dopamine 6.6 μg/Kg/min infused at the time and to the patient’s general “toxicity”.

Oddly enough, the paroxysms became prevalent following a decision, after multiple VF arrests, not to resuscitate the patient any further. They disappeared spontaneously over the ensuing 24 hours and the patient died 3 weeks later from peritonitis and sepsis47.

The paroxysms had the rate of ventricular flutter and the form of torsade de pointes, both “pre-fibrillatory” conditions. In this case, they were post-fibrillatoire! Spontaneous termination of flutter does not imply more benign prognosis; a similar case is illustrated in Schamroth’s classic Vulgaria et Exotica48.

Confusion exists about the terminology of very rapid (>300/min) ventricular rhythms; many would undoubtedly been called ventricular fibrillation without the knowledge that the paroxysms were self-terminating49.

More is shown in Fig 47a.

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