Thank you all for your answers to this week’s challenge!
shows wide QRS complex #tachycardia
. In general, the differential diagnosis comprises supraventricular tachycardia or #atrial
flutter with aberrancy or preexcitation or #ventricular
tachycardia (VT). There are multiple clues in the tracing that give away the correct #diagnosis
, which is #fascicular
VT. First, there is apparent AV dissociation (Figure 2 – clearly visible P waves in lead V1 are marked by blue arrows), which rules out SVT with aberrancy. Additionally, there are two narrower QRS complexes in the second part of the tracing (Figure 2 – red arrows), which further supports the VT diagnosis. Those are fusion beats between ongoing VT and sinus beats conducted through the AV node. Note that there are visible P waves preceding those fusion beats.
The QRS are relatively narrow during VT and morphology has typical morphology of bifascicular block (left anterior hemiblock + right bundle branch block). As there is no structural heart disease present, the most likely diagnosis is idiopathic fascicular VT (Belhassen-type VT, verapamil-sensitive VT). #Verapamil
is the method of choice for termination of this #arrhythmia
.The patient underwent later successful #catheter #ablation
and is free of recurrences without any medication.
1. Lin FC, Finley CD, Rahimtoola SH, Wu D. Idiopathic paroxysmal ventricular tachycardia with a QRS pattern of right bundle branch block and left axis deviation: A unique clinical entity with specific properties. Am J Cardiol. 1983;52:95–100.
2. Belhassen B, Rotmensch HH, Laniado S. Response of recurrent sustained ventricular tachycardia to verapamil. Br Heart J. 1981;46:679–82.
A big thank you to Petr Peichl, MD, Ph.D., Department of Cardiology, IKEM, Prague, for sending in this interesting case!
#cardiology #arrhythmia #ESCCoT #ecgcase #cardiologist #EHRA #instacardio #doctor #medecine