VEB Couplet

Report:

Sinus tachycardia 126/min

VEBs, one couplet

Ventricular fusion

Left bundle branch block

Comment:

To tell the truth, I reported only a single VEB here during my routine reporting; I kept the tracing as an example of a VEB narrower (perhaps through some fusion, in this case) than the conducted sinus beats. Later, measuring the obvious VEB ( qR in V1) against its neighbours, I noticed that the preceding beat is also narrower than the others – another fusion beat.

The second VEB in the couplet has a shorter PR interval and, accordingly, greater ventricular contribution to its QRS. It need not necessarily be a fusion beat; it may arise from the distal, unblocked portion of the left bundle branch. Its QR morphology, with much taller R waves in V2 and V3, may also represent a “focus” in the posteroseptal mitral annulus131.

The seventh complex is also a fusion beat, identical to the first VEB in the couplet. 182. Lead 2 strip of a 59 year old man with primary congestive cardiomyopathy, admitted with decompensated LV failure.

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