Runs of Ventricular Tachycardia

Report:

Runs of monomorphic ventricular tachycardia 155/min

Spontaneous termination

Atrial and junctional escape beats

Sinus tachycardia

SVEBs ?multifocal atrial tachycardia

Intraventricular conduction defect, possibly LBBB

Comment:

The patient's arrhythmias settled following intubation for pulmonary œdema; no antiarrhythmic drugs were used since then. This is common in ICU patients, whose arrhythmias are more often predicated on abnormal physiology rather than ischæmia and myocardial scarring. It remains true even if, as in this case, there is considerable pre-existing myocardial disease.

The VT runs resemble, superficially, ventricular flutter. The rate is, however, too slow and the QRS can still be separated from its ST/T segment. Also, while one lead may look like ventricular flutter, others need not.

The MCL1 monitoring lead shows LBBB as rSr’ complex, for unknown reason. The secondary R wave was not seen in V1 in the 12-lead ECG. Almost any configuration can at times occur in rhythm strips.

An episode of onset of VT with a fusion beat is shown below (Fig 86a).