Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:975 - Vol. 71 Num.11 DOI: 10.1016/j.rec.2018.02.017

Response to ECG, October 2018

Moisés Rodríguez-Mañero a,, Laila González-Melchor a, Xesús Alberte Fernández López a

a Unidad de Arritmias, Servizo de Cardioloxía, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, A Coruña, Spain

Refers to

Free articleECG, October 2018
Moisés Rodríguez-Mañero, Laila González-Melchor, Xesús Alberte Fernández López
Rev Esp Cardiol. 2018;71:859
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Article

The electrocardiogram of the tachycardia (Figure 1) shows left bundle branch block morphology and an inferior axis, with a QRS width > 160 ms. It also shows a Q wave in the aVR lead > 40 ms. These observations point to ventricular tachycardia (VT). The RS interval of 95 ms is at the limit of normal. Figure 1 shows an intraventricular conduction disorder (IVCD) in sinus rhythm.

Figure 1.

As can be seen in Figure 2, the morphology of tachycardia is reproduced with change in the QRS morphology during an atrial pacing train, indicating aberrantly conducted supraventricular tachycardia (response 2, correct). With the extrastimuli test, nodular re-entry tachycardia was induced (simultaneous VA, indicated with an asterisk in Figure 2), with a return cycle from the apex to the right ventricle of 177 ms (Figure 2).

Figure 2.

Datino et al.1 showed by atrial pacing that the specificity of classic VT criteria decreases considerably in the case of IVCD (consequently answers 1 and 3 are incorrect). In these cases, the R wave peak time in lead II ≥ 50 ms (45 ms in this case; Figure 2) and the absence of RS complexes in precordial leads have high specificity and sensitivity for diagnosis of VT (0.97 and 0.88, respectively).

Corresponding author: moirmanero@gmail.com

Bibliography

1. Datino T, Almendral J, Avila P, et al. Specificity of electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardia in patients with intraventricular conduction defect. Heart Rhythm. 2013;10:1393-401.

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

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