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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:395 - Vol. 71 Num.05 DOI: 10.1016/j.rec.2017.12.004

Response to ECG, April 2018

José Amador Rubio a,, Pablo Robles a, Elena Magallanes-Ribeiro a

a Unidad de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain

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Free articleECG, April 2018
José Amador Rubio, Pablo Robles, Elena Magallanes-Ribeiro
Rev Esp Cardiol. 2018;71:294
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An initial R wave in aVR is a diagnostic criterion for ventricular tachycardia1 (response 1 incorrect). A QRS:P ratio of 1:1 is observed (more visible in aVL and V1); this is typical of supraventricular tachycardias, but more than 30% of ventricular tachycardias can show ventriculoatrial (VA) conduction2 (response 2 incorrect). Although the tachycardia did not resolve with amiodarone administration, retrograde conduction was reduced. Moreover, a VA ratio of 2:1 is observed in the rhythm strips (recorded after drug administration) (Figure 1, upper strip; P waves are marked with red circles) or occasional VA conduction (Figure 1, lower strip). The presence of more QRS than P waves practically confirms diagnosis of ventricular tachycardia (response 3 correct), supported already by the patient's history and QRS morphology in the ECG. The first electrical cardioversion of 100 J was not effective (response 4 incorrect) but a second discharge of 150 J did lead to resolution (Figure 1). Figure 2 shows the ECG after cardioversion.

Figure 1.

Figure 2.

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1. Vereckei A, Duray G, Szénási G, Altemose GT, Miller JM. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm. 2008;5:89-98.
2. Wellens HJ, Bar FW, Lie KI. The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. Am J Med. 1978;64:27-33.

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved