Dimorphic (Alternating) Ventricular Tachycardia

Report:

Ventricular tachycardia 182/min

Comment:

The rhythm is slightly irregular and, at least in V1, there are two, possibly three, different morphologies; this is, by itself, would be evidence for ventricular ectopic origin. More likely, however, judging from V2, the V1 changes are due to respiratory movement. The axis is positive, approximately +100o, in the frontal plane; this has some diagnostic significance in the presence of what may be construed as LBBB-like QRS morphology in V1-2.

Another paroxysm occurred 45 minutes later: uniform, but with still another morphology (below, Fig 5a). The patient eventually reverted to his baseline AV sequential pacemaker rhythm (Fig 5b) on amiodarone drip in CCU.

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