Localisation of Ventricular Tachycardia by Surface ECG

Localisation of Ventricular Tachycardia by Surface ECG Surface ECG can be used to identify the site of origin of ventricular tachycardia. QRS morphologic patterns and vectors are helpful in discerning the activation pattern of the myocardium. Chest wall deformity as well as metabolic and drug effects can cause limitations in analysis sometimes [1]. Identification of site of origin of VT is useful while planning catheter ablation. It is also useful in correlating with the clinical situation as in post myocardial infarction scar related VT. Another instance is for correlation with findings on imaging modalities like echocardiography and cardiac magnetic resonance imaging [2]. Fascicular VT is one type, the site of origin of which is familiar to most of us. Original description dates back to Belhassen et al in 1981 [3]. Left posterior fascicular VT has a right bundle branch block pattern with left superior axis and RS complexes in V5, V6. Scar VT after inferior wall myocardial infarction can resemble fascicular VT, though the QRS will be wider. Idiopathic Fascicular Ventricular Tachycardia (Belhassen’s Ventricular Tachycardia):  12 lead ECG of Idiopathic Fascicular Ventricular Tachycardia showing classical right bundle branch block (RBBB) pattern with left axis deviation suggestive of posterior fascicular origin. (Courtesy: Francis J, Gupta AK et al) [4].Left anterior fascicular VT has RBBB morphology with right axis deviation. Upper septal fascicular VT has a narrower QR...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs