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It is important to recognise this pattern because this site of origin of the VT cannot be treated with catheter ablation in contrast to the tachycardias depicted in panel A and B C, Eje QRS: Symptoms — Symptoms are not useful in determining the diagnosis, but they are important as an indicator of the severity of hemodynamic compromise.

Fusion beats and capture beats are more commonly seen when the tachycardia rate is slower. In ARVD there are three predilection sites in the right ventricle: Symptoms are primarily due to the elevated heart rate, associated heart disease, and the presence of left ventricular dysfunction [4,6,7]. Left panel VT; right panel same patient during sinus rhythm.

The presence of hemodynamic stability should not be regarded as diagnostic of SVT [4,10]. In fact, there is an important rule in LBBB shaped VT with left axis deviation that cardiac disease should be suspected and that idiopathic right ventricular VT is extremely unlikely.

Now the frontal QRS axis is inferiorly directed. The origin of the QRS rhythm may be in the AV junction, with associated intraventricular aberration, or in fascicular or ventricular tissue. QRS relativamente estrecho 0. TV Eje izquierdo frontal V6 Marriott6 described that in RBBB shaped tachycardia, presence of a qR or R complex in lead V1 strongly argued for a ventricular origin of the tachycardia, while a three phasic RSR pattern suggested a supraventricular origin.

As shown by the accompanying tracing, during sinus rhythm anterior wall myocardial infarction is present in the left panel and inferior wall myocardial infarction in the right one.

As shown in fig 11, a very wide QRS is present during sinus rhythm because of sequential activation of first the right and then the left ventricle. However, VT must be considered in younger patients, particularly those with a family history of ventricular arrhythmias or premature sudden cardiac death.


When the arrhythmia arises in the lateral free wall of the ventricle sequential activation of the ventricles occurs resulting in a very wide QRS. Three types of idiopathic VT arising in or close to the outflow tract of the right ventricle see text. Many of these tachycardias are benign, and occur in the absence of structural heart disease.

SVT is more likely in younger patients positive predictive value 70 percent. See “Pharmacologic interventions” below and see “Uncertain diagnosis” below [3,4]. The following findings are helpful in establishing the presence of AV dissociation. The first occurrence of the tachycardia after an MI strongly implies VT [7]. Idiopathic outflow tract tachycardias are usually exertion or stress related arrhythmias. In the presence of AV dissociation, one may also observe fusion beats which may result from the fusion of a P wave conducted to the ventricles.

This type of re-entry may occur in patients with anteroseptal myocardial infarction, idiopathic dilated cardiomyopathy, myotonic dystrophy, after aortic valve surgery, and after severe frontal chest trauma. If all precordial leads are predominantly positive, the differential diagnosis is an antidromic tachycardia using a left sided accessory pathway or a VT. Note the baseline QT prolongation, with abrupt lengthening of the QT interval after the pause, followed by the onset of polymorphic ventricular tachycardia, which suddenly terminates.


The first criterion is the presence of a positive and dominant R wave in lead aVR, and the second is based on the vi: The origin of this QRS rhythm cannot be known with certainty, and may be supraventricular with intraventricular aberration, junctional, or ventricular.

As described in the text, lead V1 during LBBB clearly shows signs pointing to a supraventricular origin of the tachycardia. More importantly, the presence of an ICD implies that the patient is known to have an increased risk of ventricular tachyarrhythmias and suggests strongly but does not prove that the patient’s WCT is VT. The simplified aVR algorithm classified wide QRS complex tachycardias with the same accuracy as standard criteria elrctrica our previous algorithm and was superior to the Brugada algorithm.

Note the prominent broad R wave in leads V1 and V2. Notches in the T waves, signifying atrial depolarizations, are present cardiiversion 1: Ventricular Pared ventricular lateral libre….


No utilizar envases de PVC.

cardioversion electrica sincronizada pdf creator

It arises on or near to the septum near the left posterior fascicle. Si no se sincroniza: On the right a VT arising on the right side of the interventricular septum results cardiovresion more simultaneous activation of the right and left ventricle than during sinus rhythm and therefore a smaller QRS complex.

They are often amenable to cure by radiofrequency ablation. Sobre el proyecto SlidePlayer Condiciones de uso.

When the rate is approximately beats per minute, atrial flutter with aberrant conduction should be considered, although this diagnosis should not be accepted without other supporting evidence. As shown in fig 7, a VT origin in the apical part of the ventricle has a superior axis to the left of Of course other factors also play a role in the QRS width during VT, such as scar tissue after myocardial infarctionventricular hypertrophy, and muscular disarray as in hypertrophic cardiomyopathy.

The QRS complexes have an LBBB pattern, but because ventricular depolarization may not be occurring over the normal AV node His-Purkinje pathway, definitive statements about underlying intraventricular conduction delay cannot be made.

Puede existir y no ser obvia en ECG. The term “capture beat” implies that the normal conduction system has momentarily “captured” control of ventricular activation from the VT focus. If the axis is inferiorly directed, lead V6 often shows an R: In the discussions that follow, patients are categorized as follows: Give me the paddles! Muesca en descenso inicial del QRS neg.

One to one ventriculo-atrial conduction during VT. It is also important to establish whether a cardiac arrhythmia has occurred in the past and, if so, whether the patient is aware of the etiology.

In the setting of AMI, the latter is more likely. It is of interest that a QRS width of more than 0. In some cases of VT, the ventricular impulses conduct backwards through the AV node and capture the atrium referred to as retrograde conductionpreventing AV dissociation [21].