LBBB-like Ventricular Tachycardia
Report:
Ventricular tachycardia 168/min
Comment:
Some would say that the precordial pattern is that of negative concordance. A purist would point out that there are small R waves in V2 or V6; the complexes are not all completely negative. This fortunately matters little, since only positive concordant pattern can be used to diagnose VT. Here the diagnosis rests with the late (> 0.06â) S wave nadir in V1. Its QRS onset is earlier than it appears â it can be timed from V2-3 below.
As with the negative concordance, the LAD is of no diagnostic value in determining the origin of this tachycardia; half the LBBBs seen in clinical practice have LAD.
This unlucky patient had a failed ablation and remained on unpleasant and equally unsuccessful drug treatment. The latter accounts for his bradycardia in sinus rhythm (Fig 222a below).
222a. Post-amiodarone cardioversion ECG. 223. 78 year old man with permanent pacemaker.
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