Incessant fascicular VT presenting as cardiogenic shock with multi-organ dysfunction syndrome Ankur C. Thummar, MD, DM Cardiology, Ganesh Patil, MD,

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Incessant fascicular VT presenting as cardiogenic shock with multi-organ dysfunction syndrome Ankur C. Thummar, MD, DM Cardiology, Ganesh Patil, MD, Ashar Khan, MD, DM Cardiology, Yash Y. Lokhandwala, MD, DM Cardiology, Ajay U. Mahajan, MD, DM Cardiology, Pratap J. Nathani, MD, DM Cardiology Journal of Cardiology Cases Volume 13, Issue 4, Pages 101-104 (April 2016) DOI: 10.1016/j.jccase.2015.11.005 Copyright © 2015 Japanese College of Cardiology Terms and Conditions

Fig. 1 Surface electrocardiogram of ventricular tachycardia showing right bundle branch block-like pattern with left-axis deviation. There were VA conduction with 1:1 VA relationship. Journal of Cardiology Cases 2016 13, 101-104DOI: (10.1016/j.jccase.2015.11.005) Copyright © 2015 Japanese College of Cardiology Terms and Conditions

Fig. 2 2D echocardiogram short-axis views at mid-cavity level showed a dilated left ventricle with poor contractility. (A) End-systolic frame. (B) End-diastolic frame. Journal of Cardiology Cases 2016 13, 101-104DOI: (10.1016/j.jccase.2015.11.005) Copyright © 2015 Japanese College of Cardiology Terms and Conditions

Fig. 3 Electrophysiology study. The first 2 complexes show VA conduction. After that, faster atrial pacing from the coronary sinus shows AV dissociation for 4 complexes. The last 3 atrial paced complexes conduct via the AV node, with normal QRS complexes. Journal of Cardiology Cases 2016 13, 101-104DOI: (10.1016/j.jccase.2015.11.005) Copyright © 2015 Japanese College of Cardiology Terms and Conditions

Fig. 4 Ventricular tachycardia (VT) terminates with a capture beat, and then initiates spontaneously. The capture beat suggests AV nodal duality, as the retrograde A turns around via the “fast” pathway and reaches the ventricle early. It also suggests the VT focus to be close to the conduction system. The normal complex after termination shows the ‘memory sign’ T inversion in the inferior leads. Journal of Cardiology Cases 2016 13, 101-104DOI: (10.1016/j.jccase.2015.11.005) Copyright © 2015 Japanese College of Cardiology Terms and Conditions