March 11, 2017

Fast Rhythm: VT or reentry?

VT or reentry?

Image 1 - ECG case

This is a regularly irregular rhythm at a rate of 100-180's. There are wide QRS beats RBBB and LBBB morphology.

Image 2 - Sinus P waves marked

We can still march the P waves (red). So, the rhythm is still sinus but interrupted by 2 beats of QRS with RR cycle length (CL) of about 320 ms.

Image 3 - Ladder diagram

If we go back to the previous strips, we know that there are premature or there are junctional beat that is trying to reenter (echo beats). So, we are looking at a reentry phenomenon (if there are only one or 2 complexes). If it continues then it is called reentry tachycardia (which is not the case here). Of note is that the reentry complexes are conducted with aberrancy.

This strip is from the same patient in cases:


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