Acute Anterior MI: Frequent R-on-T VEBs
Report:
Sinus rhythm 64/min
Frequent R-on-T VEBs
Extensive acute anterior infarction
Comment:
This VEB density (a Holter term) would have evoked xylocaine reflex4 until quite recently. Lown Class V ventricular ectopic activity5 even more so. However, in monitored CCU patients antiarrhythmic drugs make no difference. In this instance, no specific therapy was used and nothing happened.
VEB frequency (“density”) is of course difficult to quantify on a single ECG; some would say that even a single one (as below, Fig 9a) implies frequent occurrence. However frequent, however, they rarely require treatment.
As to the R-on-T phenomenon, as many instances of VF or VT follow late as early VEBs. In this setting they are best left alone.
That is not to say that patients with documented episodes of VT or VF should not receive antiarrhythmic drugs. It is only the “warning arrhythmias” and the prophylaxis that have had their day in CCU.
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