R-on-T VEB: Ventricular Fibrillation

Report:

Sinus rhythm 92/min (top)

R-on-T VEB

Ventricular fibrillation

DC defibrillation (third strip)

Post-countershock sinus bradycardia, VEB

Sinus tachycardia 115/min (bottom)

Comment:

A reperfusion arrhythmia is not expected a day after. At any rate, arrhythmias are not as good a marker of reperfusion as the diminution of the ST segment elevation. Also, AIVR rather than VF is typical of reperfusion.

The R-on-T ectopic triggers what some authorities would call ventricular tachycardia; it then (after 5 beats) “degenerates” into VF. Definitional problems like this have always been with us. I prefer to call the entire run VF ab initio.

216. 58 year old man in Casualty, distressed but unable to describe it.

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