WIDE-QRS TACHYCARDIAS

ACCELERATED VENTRICULAR RHYTHMS

ACCELERATED VENTRICULAR RYTHM

In bygone days, this rhythm was called “slow ventricular tachycardia”. A better term today is “accelerated ventricular rhythm, to emphasize that, unlike the reentrant circuitry of V.T., this rhythm is due to an automatic focus – a disturbance of FORMATION rather than disturbed impulse CONDUCTION. Most often, it is identified in patients with acute M.I.. Studies have indicated that the “irritable focus” surfaces after spontaneous coronary artery opening, and when a flow of blood arrived in the jeopardized tissue.

Virtually all of our criteria are present. The rhythm is regular and the complexes are “wide-wide”. The axis is negative in leads I and aVF and is in “ no man’s land”. The monomorphic large QRS in V1 is clearly not typical RBBB. Although there is no concordance, Brugada ‘s #1 criterion is present. As a finale, a few dissociated P waves are peeking out.