Slow Ventricular Tachycardia
Report:
Ventricular tachycardia 120/min
Comment:
The morphology in V1, with dominant left rabbit ear in a monophasic R complex, and of positive precordial concordance, is practically diagnostic of ventricular ectopic origin.
This tracing is of interest because it illustrates one of the problems with ICDs programmed for faster tachycardias. The patient, by then experienced in the ways of hospitals, asked (and got) a 30 Joule countershock and went home without ever trying antiarrhythmic drugs in Casualty.
Another point of interest is the computer ârecognitionâ of atypical P waves, presumably in lead 1 and the mid-precordial leads, diagnosing âatrial tachycardiaâ (Fig 123a). This was, at least, consistent with further errors in describing ventricular conduction as âRBBB & LAFBâ. The marked right axis deviation (if anything, should be LPHB in the computer) has no diagnostic significance here: it is only relevant for VT if lead V1 shows LBBB-like morphology.
In sinus rhythm (not shown, poor photocopy) the patient had RBBB of QR variety due to an old anterior MI and frontal axis of about 260o, possibly due to combination of LAHB and deep Q waves in lead 1. The computer may have had psychic abilities of its own, pronouncing on the âLAFBâ.
123a. Pseudo P waves in lead 1 misled the computer.
124. 61 year old with past history of infarction and CABGs, following out-of-hospital arrest and numerous episodes of VT/VF.
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