Ventricular Arrhythmias

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Presentation transcript:

Ventricular Arrhythmias J. William Schleifer, MD, Komandoor Srivathsan, MD Cardiology Clinics Volume 31, Issue 4, Pages 595-605 (November 2013) DOI: 10.1016/j.ccl.2013.07.007 Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 1 Criteria for diagnosing a wide QRS complex tachycardia as VT. AV, atrioventricular; LBBB, left bundle branch block; RBBB, right bundle branch block. Cardiology Clinics 2013 31, 595-605DOI: (10.1016/j.ccl.2013.07.007) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 2 12-lead ECG showing monomorphic VT. This ECG shows a regular monomorphic tachycardia with a wide QRS of 160 milliseconds and an atypical QRS morphology in the precordial leads. The Brugada criteria can be applied. Step 1: There is an R wave in V1, so continue to step 2. Step 2: the longest RS interval in a precordial lead is slightly more than 100 milliseconds in V5 and is thus consistent with VT, even although no atrioventricular dissociation (step 3) is visible. Step 4: R is greater than R′ in V1, and S is greater than R in V6, meeting morphologic criteria for VT in V1 and V6. Cardiology Clinics 2013 31, 595-605DOI: (10.1016/j.ccl.2013.07.007) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 3 12-lead ECG showing coved ST segment elevation in leads V1 to V3 in a patient with Brugada syndrome. Cardiology Clinics 2013 31, 595-605DOI: (10.1016/j.ccl.2013.07.007) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 4 12-lead ECG showing the initiation of TdP with a long-short sequence occurring in the setting of a prolonged QT interval. Cardiology Clinics 2013 31, 595-605DOI: (10.1016/j.ccl.2013.07.007) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 5 Use of an Impella device for percutaneous hemodynamic support in a patient with intractable VT. The arrow indicates the tip of the Impella catheter within the left ventricle. A defibrillator lead is also seen in the right ventricular apex. Cardiology Clinics 2013 31, 595-605DOI: (10.1016/j.ccl.2013.07.007) Copyright © 2013 Elsevier Inc. Terms and Conditions

Fig. 6 Therapeutic protocol for treating ES. IV, intravenous. Cardiology Clinics 2013 31, 595-605DOI: (10.1016/j.ccl.2013.07.007) Copyright © 2013 Elsevier Inc. Terms and Conditions