Slow Ventricular Tachycardia
Report:
Ventricular tachycardia 116/min
Retrograde conduction
Probable acute anterior infarction
Comment:
The basic LBBB-like morphology with RAD alone designates the tachycardia as ectopic ventricular27; its slurred S downslope in V1-2 is also diagnostic1. The rate is slow and some authorities would call it AIVR. I feel itâs best to draw the line at 100/min for all tachycardias.
Below (Fig 191a) is the trace in sinus rhythm, showing late-diastolic bigeminal VEBs of the same morphology as the VT. This in itself is another line of evidence for the broad-complex tachycardia being ectopic ventricular. Despite the sinus P waves preceding the VEBs, there is no fusion: the PR interval is shortened by more than 0.06â from that of the sinus beats. In V1, however, the dissociated P waves preceding the VEBs look different from P waves preceding normal complexes: this is because the initial VEB complex is isoelectric there, ironing out the negative part of the P wave.
191a. Same ectopic morphology, in bigeminy. 192. 67 year old man with history of myocardial infarction, following AAA repair.
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