Fascicular VT With Retrograde 2:1 Block
Report:
Ventricular tachycardia 122/min
Retrograde 2:1 V-A block
Retrograde 1o VA block (RP 0.24â)
Comment:
The tachycardia originates in the posterior-inferior fascicle of the left bundle branch - it looks like atypical RBBB + LAHB. Despite the relatively slow rate, the patient was distressed by palpitations and required cardioversion. The sinus rhythm trace (Fig 158a) shows widespread T wave inversion, presumably due to the preceding abnormal conduction in VT. Conduction, rather than rapid rate, appears responsible for this âpost-tachycardia syndromeâ.
The presence of retrograde 2:1 block is in itself evidence of ventricular ectopic origin of the broad-complex tachycardia5. It is rarely mentioned because it is rarely seen. The retrograde P waves in alternate cycles are readily seen in many leads. In V4 they mimic repolarisation alternans.
Fascicular VT has been frequently reviewed122.
158a. Post-tachycardia T wave inversion. 159. 27 year old woman with ARDS and hypokalæmia.
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