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SVT not associated with structural cardiac disease or drug presence, for example, would be expected to show rapid initial forces and delayed mid-terminal forces.


Note the prominent broad R wave in leads V1 and V2. Nondiagnostic J point elevation in precordial leads V1 and V2. BRHH preexistente ancianos con fibrosis sist. An atrial rate that is faster than the ventricular rate is seen with some SVTs, such as atrial flutter or suncronizada atrial tachycardia with 2: Note the baseline QT prolongation, with abrupt lengthening of the QT interval after the pause, followed by the onset of polymorphic ventricular tachycardia, which ccardioversion terminates.

Eje muy negativo QRS axis in the frontal plane The QRS axis is not only important for the differentiation of the broad QRS tachycardia but also to identify its site of origin and aetiology. 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. The resulting QRS complex has a morphology intermediate between that sincronizaea a sinus beat and a purely ventricular complex show ECG 9.


Of course, QRS width is not helpful in differentiating VT from a tachycardia with AV conduction over an accessory AV pathway because such a pathway inserts into the ventricle leading to eccentric ventricular activation and a wide QRS carsioversion fig 6.


Notches in the T waves, signifying atrial depolarizations, are present in 1: Ventricular bigeminy is present, likely originating from the same focus as the tachycardia. See “General principles of the implantable cardioverter-defibrillator”. See “Pharmacologic interventions” below and see “Uncertain diagnosis” below [3,4].

Also the presence of AV conduction disturbances during sinus rhythm make it very unlikely that a broad QRS tachycardia in that patient has a supraventricular origin and, as already shown in fig 11, a QRS width during tachycardia more narrow that during sinus rhythm points to a VT.

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 with the VT QRS complex.

That area is difficult to reach by retrograde left ventricular catheterisation and when catheter ablation is considered an atrial transseptal catheterisation should be favoured. This does not hold for an LBBB shaped tachycardia.

On the right a VT arising on the right side of the interventricular septum results in more simultaneous activation of the right and left ventricle than during sinus rhythm and therefore a smaller Cardioersion complex. When the arrhythmia arises in the lateral free wall of the ventricle sequential activation of cardioversiion ventricles occurs resulting in a very wide QRS. Los botones se encuentran debajo. AV dissociation may be present but not obvious on the ECG. During tachycardia the QRS is more narrow.


This is a tachycardia not arising on the endocardial surface of the right ventricular outflow tract but epicardially in between the root of the aorta and the posterior part of the outflow tract of the right ventricle.

Of course other factors also play a role in the QRS width during VT, such as scar tissue after myocardial infarctionventricular hypertrophy, and muscular disarray as in hypertrophic cardiomyopathy. An antidromic circus movement tachycardia with AV conduction over a right sided caridoversion pathway. Patients are eelectrica to carry identification cards providing information about such devices, which can facilitate device interrogation.

In the setting of AMI, this rhythm could indicate either reperfusion or reperfusion injury. Lo primero la estabilidad del paciente TCA.

cardioversion electrica sincronizada pdf creator

Misdiagnosis of VT as SVT based upon hemodynamic stability cardioversoin a common error that can lead to inappropriate and potentially dangerous therapy. It is important in the differential diagnosis of various entities, in particular mild or subclinical forms of arrhythmogenic right ventricular cardiomyopathy. It may occur in AV junctional tachycardia with BBB after cardiac surgery or during digitalis intoxication.

Left panel VT; right panel same patient during sinus rhythm. Three types of idiopathic VT arising in or close to the outflow tract of the right ventricle see text. These notches might be P electgica, or part of the QRS complexes themselves.

A diagnosis of myocardial ischemia or infarction cannot be made with certainty in the presence of a left intraventricular conduction delay.