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 Table of Contents  
QUIZ TIME
Year : 2015  |  Volume : 1  |  Issue : 1  |  Page : 72-73

Electrocardiography quiz


Department of Cardiology, PGIMER, Chandigarh, India

Date of Web Publication22-May-2015

Correspondence Address:
Dr. Parag Barwad
Department of Cardiology, PGIMER, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-5414.157578

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How to cite this article:
Barwad P. Electrocardiography quiz. J Pract Cardiovasc Sci 2015;1:72-3

How to cite this URL:
Barwad P. Electrocardiography quiz. J Pract Cardiovasc Sci [serial online] 2015 [cited 2019 Jul 20];1:72-3. Available from: http://www.j-pcs.org/text.asp?2015/1/1/72/157578


  ECG Quiz Top


Question - analyze the ECG [Figure 1].
Figure 1: Electrocardiography for quiz.


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  Clinical Details Top


A 32-year-old male patient had an episode of palpitation lasting for 3 h. The onset was abrupt, but there was no hemodynamic compromise. There is a history of similar episodes since last 2 years, lasting for few hours with spontaneous termination. However, required intravenous verapamil for termination on few occasion. The echocardiogram done was normal.

Electrocardiography features

  • Regular tachycardia with right bundle branch block (RBBB) morphology, QRS duration of 120 ms
  • Left axis deviation
  • Inverted P waves are seen, best in lead III (red arrow)
  • Constant QRS and P relationship (red arrow).


Interpretation [Figure 2]
Figure 2: Electrocardiography quiz answer.


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  • Broad, complex regular tachycardia in young patients is usually supraventricular tachycardia with aberrancy
  • However, any broad complex tachycardia not fulfilling the criteria for a typical bundle branch block (RBBB or left bundle branch block), may be a tachycardia of ventricular origin
  • RBBB usually has an associated right axis deviation
  • Thus, the present patient has a ventricular tachycardia (VT) arising from the left posterior fascicle (fascicular VT)
  • Though atrioventricular dissociation is a diagnostic feature for VT, this is seen in only 50% of patients. In fact, up to 25% of patients in VT may have 1:1 ventriculoatrial conduction, as shown, in this case.


Further case details: The patient was taken-up for electrophysiological study, which showed recurrently inducible left posterior fascicular VT, for which a successful radiofrequency ablation was performed.

Comments

  • Fascicular VT is a relatively benign variety of VT arising from the left ventricle with re-entry within the posterior left fascicle as the possible mechanism
  • Electrocardiography characteristics of fascicular VT are RBBB with left axis deviation/northwest axis, with relatively narrow QRS
  • This tachycardia usually does not cause hemodynamic compromise and occur in younger population
  • However, in few patients incessant tachycardia may cause left ventricular dysfunction
  • Verapamil/Diltiazem is effective in terminating this VT; Adenosine is ineffective
  • Radiofrequency ablation has a success rate of 90%
  • Early recognition and differentiating it from other VTs is important in view of its treatment strategy.





    Figures

  [Figure 1], [Figure 2]



 

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