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Now the frontal QRS axis is inferiorly directed. While the presence of AV dissociation largely establishes VT as the diagnosis, its absence is cardoiversion as helpful for two reasons: Duration of the tachycardia — SVT is more likely if the tachycardia has recurred over a period of more than three years [6].

In this setting, emergent synchronized cardioversion is the treatment snicronizada choice regardless of the mechanism of the arrhythmia. An antidromic circus movement tachycardia with AV conduction over a right sided accessory pathway.

Regularity — VT is generally regular, although slight variation in the RR intervals is sometimes seen. See “Pharmacologic interventions” below and see “Uncertain diagnosis” below [3,4]. In the setting of AMI, the latter is more likely.

cardioversion electrica sincronizada pdf creator

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. Idiopathic outflow tract tachycardias are usually well tolerated, probably because of the preserved ventricular function. 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.

Often, no treatment is required, and the rhythm disturbance is self-limited. In ARVD there are three predilection sites in the right ventricle: Eur Heart J ; Findings consistent with hemodynamic instability requiring urgent cardioversion include hypotension, angina,altered level of consciousness, and heart failure.


Figure 12 gives an example of QR complexes during VT in patients with an anterior panel A and an old inferior myocardial infarction panel B. It arises on or near to the septum near the left posterior fascicle. Notches in the T waves, signifying atrial depolarizations, are present sincronizsda 1: Some patients crdioversion a WCT have few or no symptoms palpitations, lightheadedness, diaphoresiswhile others have severe manifestations including chest pain or angina, syncope, shock, seizures, and cardiac arrest [6].

In the discussions that follow, patients are categorized as follows: Because the mean frontal plane QRS axis of the tachycardia complexes is inferiorly directed, the focus of origin is at or near the base of the ventricle, with ventricular depolarization proceeding from base to apex. These notches might be P waves, or part of the QRS complexes themselves.

Sudden narrowing of a QRS complex during VT may also be the result of a premature ventricular depolarisation arising in the ventricle in which the tachycardia originates, or it may occur when retrograde conduction during VT produces a ventricular echo beat leading to fusion electrics the VT QRS complex.

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.

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.

cardioversion electrica sincronizada pdf creator

During tachycardia the QRS is more narrow. An inferior axis is present when the VT has an origin in the basal area of the ventricle. 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.

Ventricular Pared ventricular lateral libre…. Symptoms — Symptoms are not useful in determining the diagnosis, but they are important as an indicator of the severity of hemodynamic compromise.



This tachycardia arises more anteriorly close to the interventricular septum. Symptoms are primarily due to the elevated heart rate, associated elsctrica disease, and the presence of left ventricular dysfunction [4,6,7].

As described in the text, lead V1 during LBBB clearly shows signs pointing to a supraventricular origin of the tachycardia. However, VT must be considered in younger patients, particularly those with a family history of ventricular arrhythmias or premature sudden cardiac death. The presence of hemodynamic stability should not be regarded as diagnostic of SVT [4,10]. This does not hold for an LBBB shaped tachycardia. In the setting of AMI, this rhythm could indicate either reperfusion or sincrojizada injury.

TV Eje izquierdo frontal Elwctrica Marriott6 described that in RBBB shaped tachycardia, presence of a qR or R complex in lead V1 strongly sincromizada for a ventricular origin of the tachycardia, while a three phasic RSR pattern suggested a supraventricular origin. In the right panel ventricular activation starts in the left posterior area, resulting in positive concordancy of all precordial leads. It may occur in AV junctional tachycardia with BBB after cardiac surgery or during digitalis intoxication.

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: The purpose of this study was to further simplify the algorithm by omitting the complicated morphologic criteria and restricting the analysis to lead aVR. When the sincronizaea of the carddioversion is available for analysis, a period of irregularity “warm-up phenomenon”suggests VT.

The QRS complex will be smaller when the VT has its origin in or close to the interventricular septum.