EXTRA COPY - VT Criteria - EXTRA COPY

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Figure-1: XXXX (To improve visualization — I've digitized the original ECG using PMcardio).

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Figure-2: XXXX

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Figure-3: XXXX

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Acknowledgment: My appreciation to Mohammed Elsisi (from Benha City, Egypt) — for allowing me to use this case and this tracing.

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Mohammed Elsisi <mohammedelsisi18@gmail.com>  (EMAIL on 7/14/2026)

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—   ­VT Criteria ... ­—

 

 

Acknowledgment: My appreciation to Mohammed Elsisi (from Cairo, Egypt) for the case and these tracings.

 

This tracing was obtained from a 60 y male pt with free medical hx apart from recurrent palpitation over last 5y, who recently become short of breath & exoerience progreesive ll swelling & presented to the ER. 

Pt was received 2 amp amiodarone with no effect, sync dc shocks also convert rhythm transiently on monitor then rapidly return to this tachy. 

My differential is : 

1)LPF VT

2)Aberrant AFL rhythm is strictly ~150bpm

3)aberrant svt 

Woth this incessant rhythm causes tachycardia induced cardiomyopathy. 

What do u think? 

MY REPLY:

Hi Mohammed.

 

I agree that this regular WCT ( = Wide-Complex Tachycardia) looks like LPF VT!

• The QRS is wide; the rhythm is regular without clear sign of sinus P waves.
• This does NOT look like aberrant conduction.Lead V1 does not show the triphasic rsR’ that characterizes aberrant conduction — and note that the QRS stays predominantly positive for ALL 6 chest leads (which does not generally happen when there is RBBB conduction). In the limb leads — the R in lead I is slow rising, and there is no more than a tiny r wave in the inferior leads — so QRS morphology is atypical for rbbb/lahb conuction.
• Verapamil (not Amiodarone) is the drug of choice for a hemodynamically stable patient with Fascicular VT. Given frequent recurrence of this rhythm — I’d refer to EP for confirmation and then ablation.
• See ECG Blog #489 — for review of a case.

 

Hope the above is helpful! Let me know if you get follow-up!

 

: ) Ken

 

MOHAMMED REPLY:

Thanks ken, as i mentioned  before pt was admitted to ccu d was intubated due to cardiogenic shock d respiratory distress rhythm was incessant & resistant to dc shock. 

D over drive pacing done with succeessful conversion to sinus rhythm with morphology strictly the same during tacharrhythmia. 

Pt hemodynamics improvwd d was successfully weaned from mech

Ventilation then underwent an EP study d a dual av nodal pathway was found with reproduction of avnrt 

Finally succeessful ablation of the pathway done. 

Case finally considered tyical AVNRT. 

With tachy induced cardiomyopathy. 

MOHAMMED (7/14/2026) 

Yes, dramatic improvement after maintenance of sinus rhythm — proves this was tachycardia-induced cardiomyopathy — because EF improved after the WCT was treated !!!!

Of course u can use this case as a blog — Thanks ken. 

MY REPLY:

GREAT case! I want to use this for an ECG Blog — it may be a while — but I'll let you know when I publish this. So LV function improved once AVNRT was ablated? If so — then YES, this was a tachycardia-induced cardiomyopathy!

 

Always good to consider the possibility of an underlying abnormal ECG with similar morphology as during the WCT — which sometimes you just don't know when you first see the patient!

 

GREAT WORK on your part! 

Tha