Broad-Complex Ventricular Tachycardia

Report:

Ventricular tachycardia 163/min

Comment:

This example would be difficult to assign LBBB- or RBBB-like status in view of the RS complex in V1. Nevertheless, the QRS duration of approximately 0.20” is in excess of 0.16” required for LBBB-like VT, let alone 0.14” for RBBB-like VT. The QRS duration is not decisively diagnostic per se. The precordial appearance is in this case inconsistent with either LBBB or RBBB: it is sufficiently “bizarre” (neither meat nor fish) to qualify for ventricular ectopic origin.

The patient was shocked into sinus rhythm (Fig 8a below), revealing presumptive current ischæmia (precordial ST segment depression). The QT interval is prolonged by flecainide given before the electrical cardioversion. The sinus P waves show left atrial abnormality (LAA), with interpeak distance greater than 1mm; this is rather unspecific, but constitutes one of the criteria for LAA and as a marker of risk for AF.

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