Ventricular Tachycardia: RV1
Report:
Ventricular tachycardia 220/min.
Comment:
The patient's age and the relatively fast rate must have influenced the first choice of aberrancy in the Casualty report. The "VT with underlying WPW", however, suggests diagnostic skills beyond electrocardiography!
The tachycardia itself has monophasic R wave in V1 - unlikely to represent RBBB aberrancy and a marked RAD not morphologically suggestive of LPHB aberrancy (where a qR in inferior leads would be expected). Combined RBBB/LPHB aberrancy is relatively uncommon78.
The sinus rhythm ECG is shown below (Fig 80a). It's sole abnormality is T3 > T1 , possibly a transient aftermath of the tachycardia itself. A VT recurrence in the CCU, this time also with RV1 but LAD and probable fusion beats, is shown on the following page (Fig 80b), where QS in V6 puts paid to any notion of WPW conduction.
Verapamil therapy of possible VT represents a physiological and medico-legal challenge best avoided79 On the other hand, verapamil-sensitive VT is a distinct, however heterogeneous, entity80.
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