Comment to 'Narrow complex tachycardia in ischemic cardiomyopathy '
  • Personally I will call this wide complex tachycardia (using lead III QRS duration around 120 ms).

    heart rate around 150 bpm

    axis is normal

    Atrial activity seen after each QRS complex except the initial beat after the conducted sinus beat at the end of the rhythm strip.

    the atrial activity has positive morphology in lead aVR and negative in inferior leads which means the direction of the electrical activity from inferior to superior (ventricular tachycardia with VA conduction/atrial tachycardia/junctional or AVNRT ….)

    Unlikely atrial tachycardia given the flat line at the termination and also no atrial activity seen prior to initiation.

    certainly not atrial flutter.

    I don’t see delta wave in the conducted sinus beat.

    I will go with ventricular tachycardia (probably septal vt)

    also, the morphology of the initial r wave in V2 is more than 40 ms (not typical for LBBB) goes with VT.

    overall:

    1. Ventricular tachycardia with VA 1:1 conduction except for one beat after the conducted sinus beat (? AV node Refractory after conducted sinus beat)
    2. Old inferior MI
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