Fascicular Ventricular Tachycardia

Report:

Ventricular tachycardia 141/min

Comment:

The complexes are between 0.10 and 0.12” in duration (even narrower than in Case 11), with left axis deviation –40o. The morphology is that of incomplete LBBB except for the all-important lead V1, where there is a 1 mm broad primary R wave, delayed S wave nadir and a secondary R’ wave – features incompatible with any form of LBBB. The early transition would also be unexpected in LBBB. In fact, the patient had a typical complete LBBB (below) following cardioversion with sotalol in CCU.

V1 also shows an atrial wave in each cycle, most likely a retrograde one in view of the QRS morphology precluding a supraventricular rhythm with aberrant conduction. The RP interval of about 0.25” is a reasonably likely one, especially with sotalol on board.

The next day, LBBB resolved into LVH; the latter had a huge R wave in V4, similar to the one in VT.

13a. Typical LBBB in sinus rhythm, with normal axis. 13b. LVH with ST/T changes. Only P waves remain the same. 14. Sample of an almost incessant tachycardia in a healthy 15 year old girl on less than fully successful sotalol therapy.

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