Doxepin Overdose: IVCD

Report:

Junctional tachycardia 100/min

Intraventricular conduction delay (IVCD)

QRS 0.16”

Comment:

The QRS duration of 0.16” implies the likelihood of nasty arrhythmias27, but its clinical usefulness is limited by the fact that patients with it need monitoring for shock, coma or convulsions anyway28.

The IVCD induced by tricyclics is usually like this one, nonspecific; some patient may develop or exaggerate fascicular or bundle branch block patterns. The entire QRS is prolonged in this example.

Below (Fig 49a) is the patient’s normal ECG.

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