Cardioverter-Defibrillator During Ventricular Tachycardia

Report:

Ventricular tachycardia 133/min

Burst of overdrive pacing 160/min

Fusion beat

Comment:

This is the same patient as Case 4, five years later. The ICD does not always work, but the patient is alive, with numerous episodes of VT perhaps rendered less numerous by sotalol and magnesium therapy. There is little doubt at present (always a suspicious phrase!) that ICD is the treatment of choice for the VT/VF patients52.

The diagnosis of VT here depends, again, on the delayed S-nadir in V1 and the fact that the QRSs look like RBBB in V1 and LBBB elsewhere – my neither meat nor fish criterion. This only holds in the absence of marked LAD – excluding the masquerading BBB. Fusion does not help here – the first paced beat fuses with a VT beat: both are ventricular.

Below on this page is an instance where the pacemaker worked. The patient’s baseline ECG is shown in Fig 52a.

Fig 52a. AV-paced rhythm with long AV interval promoting narrow(er) QRS complexes. Apart from the VEB, all the beats are probably fusion beats. It is also possible that the ventricular lead does not work and the QRSs show the patient’s native IVCD. 53. 79 year old man with 90% LAD artery occlusion and impaired LV function, defibrillated in the angiography suite following RCA contrast injection. A Cardiologist reported this ECG as follows: “Sinus rhythm. VEBs. Left anterior hemiblock. Non-specific anterolateral T wave abnormalities.” His report could be improved.