Tachycardie Préfibrillatoire
Report:
Ventricular tachycardia, multiform > 300/min
?Torsade de pointes
?Ventricular flutter
Sinus rhythm
VEBs ? aberrant(RBBB) junctional premature beats
R-on-T phenomenon
Comment:
This is the fastest spontaneously terminating VT I have seen so far. Some of the speed would have been attributable to adrenaline 10 μg/min and dopamine 6.6 μg/Kg/min infused at the time and to the patientâs general âtoxicityâ.
Oddly enough, the paroxysms became prevalent following a decision, after multiple VF arrests, not to resuscitate the patient any further. They disappeared spontaneously over the ensuing 24 hours and the patient died 3 weeks later from peritonitis and sepsis47.
The paroxysms had the rate of ventricular flutter and the form of torsade de pointes, both âpre-fibrillatoryâ conditions. In this case, they were post-fibrillatoire! Spontaneous termination of flutter does not imply more benign prognosis; a similar case is illustrated in Schamrothâs classic Vulgaria et Exotica48.
Confusion exists about the terminology of very rapid (>300/min) ventricular rhythms; many would undoubtedly been called ventricular fibrillation without the knowledge that the paroxysms were self-terminating49.
More is shown in Fig 47a.
47a. These runs could also be called ventricular flutter. There are also several R-on-T VEBs in the middle strip.
48. 50 year old woman with history of anterior MI and atrial fibrillation. Serum digoxin level is in the therapeutic range.
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