Negative Concordant Precordial Pattern in VT

Report:

Ventricular tachycardia 170/min

Comment:

All the chest leads show negative QRS complexes. In VT, this used to be one of the criteria distinguishing it from aberrantly conducted SVT; now only positive concordance is still held valid as a VT criterion63. Whether concordance means that the complexes are all negative or positive, or only predominantly so (as in the reference just cited), remains a moot point.

The downstroke of the QS complex in lead V1 is slurred, with brisk upstroke. The overall QRS width is approximately 0.20”. The diagnosis is not in question, regardless of the significance of the concordant pattern. The same pattern is often seen in the known ectopic ventricular rhythm – the paced one.

Post-cardioversion ECG was completely normal (Fig 68a), but subsequent angiography showed 80% LAD artery stenosis. This was, by then, reflected in Wellens’ warning – the terminal T inversion in the V leads indicating critical LAD artery obstruction64. The question of whether the VT was caused by the coronary lesion or merely unmasked angina by way of spontaneous stress-testing remains unanswered. In this situation CABGs seem to be wiser investment than anti-arrhythmic drugs or nitroglycerin.