Ventricular or Another Atrial Tachycardia?

Report:

Ventricular tachycardia 178-180/min

Comment:

The tachycardia basic LBBB morphology with right axis deviation; the nadir of the S wave in V1 came after more than 0.06”. It looked like VT: RAD with LBBB has never been reported as aberrancy8. This combination is used, in fact, as a diagnostic criterion for ventricular ectopic origin27.

Except for one thing: the admission arrhythmia shown below (Fig 57a,) had the same atrial rate and was conducted with 2:1 block! Doubling the ventricular rate may have produced the hitherto unreported aberrancy, possibly as a result of quinidine administered prior to transfer. There are, however, slight rate variations in both traces, more easily observable below, where the trace slows a little toward the end of the recording. The likelihood of atrial tachycardia - probably flutter - with (atypical) aberrancy remains quite high but, unlike the one in Case 54, it cannot be proven.

Superimposed traces are shown in Fig 57b.

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