Cardioverter-Defibrillator During Ventricular Tachycardia

Report:

Ventricular tachycardia 133/min

Burst of overdrive pacing 160/min

Fusion beat

Comment:

This is the same patient as Case 4, five years later. The ICD does not always work, but the patient is alive, with numerous episodes of VT perhaps rendered less numerous by sotalol and magnesium therapy. There is little doubt at present (always a suspicious phrase!) that ICD is the treatment of choice for the VT/VF patients52.

The diagnosis of VT here depends, again, on the delayed S-nadir in V1 and the fact that the QRSs look like RBBB in V1 and LBBB elsewhere – my neither meat nor fish criterion. This only holds in the absence of marked LAD – excluding the masquerading BBB. Fusion does not help here – the first paced beat fuses with a VT beat: both are ventricular.

Below on this page is an instance where the pacemaker worked. The patient’s baseline ECG is shown in Fig 52a.

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