Another Variant Form of Bidirectional Ventricular Tachycardia

Report:

Bidirectional ventricular tachycardia 184/min

Comment:

Like in the preceding case, lead V1 has basic LBBB morphology. This patient, with known pre-existing LBBB, received adenosine for presumptive SVT, without effect. Sotalol, 80 mg IV, abolished the alternation and slowed the rate (Fig59a), but the VT persisted until reversed with 200 Joule countershock.

Again, the bidirectional character is seen in only one lead (Lead 3 in this case), with some alternation elsewhere. The ventricular ectopic provenance is strongly suggested by the very early transition, between V1 and V2 – most unusual for LBBB conduction. The patient’s chronic LBBB (not shown) looked quite different.

59a. Post-sotalol VT. Tendency for different conduction is still present. 60. 30 year old woman with normal heart and history of both VT and SVT. Ablation was performed following EPS for the SVT.

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