Complex Complex of Complex Complexes

Report:

Ventricular (fascicular) tachycardia 139/min

Retrograde VA block , Möbitz 1

Incomplete Wenckebach sequences

Reentry (echo) beats of ventricular origin

Comment:

As shown on the laddergram below, the longest retrograde RP interval in each triplet results in reentry at the junctional level. It is the long RP (and PR) intervals that favour reentry. It is possible, however, that the reentry starts with the retrograde P wave in the atria59. It is not possible to tell whether atrial participation in the reentry circuit is necessary – the operative circuit may be all junctional, with P’ wave just an epiphenomenon. This is one of those delightful rhythm strips usually found in the CCU paper bins. A laddergram is shown below on this page.

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