Inferior MI Reperfusion – Fascicular VT

Report:

Ventricular tachycardia 156/min/min

Probable inferior infarction

Comment:

The rhythm was sufficiently irregular for the computer to classify it as AF with borderline IVCD. It becomes more regular, however, just after the middle of the trace and ends with bigeminy. The long-short sequences, by definition, preclude the diagnosis of electrical alternans in the latter part of the tracing.

The QRS complex just makes 0.12” in duration, but has a marked LAD –45o in the frontal leads and bizarre enough morphology – almost concordant in the precordial leads – to denote a fascicular VT. In addition, there appears to be some dissociated atrial activity (or, variable retrograde conduction).

Below (Fig 78a) is a trace taken in sinus rhythm 30 hours later, with two rather narrow VEBs as a reminder of previous VTs. The inferior leads have only borderline Q waves and the repolarisation changes are minor, with slight residual reciprocal ST segment depression in V2-4.

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