What kind of AV block is this? And why does she develop Ventricular Tachycardia?

Discussion: The initial ECG in today ' s case is pathological for any patient, especially for a 50-year old previously heathy female. Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). Usually the medical history will provide clues to the cause. Even though the primary suspicion was not ischemic heart disease, a CT angiogram was performed, and it revealed normal coronary arteries. This ruled out coronary disease as the cause of conduction system disease. When assessing patients with early onset high grade conduction disorders and ventricular tachydysrhythmia in the absence of coronary disease — cardiac sarcoid should be on the list of differential diagnoses. The patient underwent an MRI and cardiac PET scan. Below are videos of the PET scan showing areas of high metabolism/uptake in the myocardium, consistent with cardiac sarcoid.The patient was transferred to a facility for cardiac biopsy. The biopsy was consistent with cardiac sarcoidosis. Medical treatment with oral steroids and methotrexate was started. She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). The ECG below was recorded after her device was implanted. The ECG shows atrial sensing and biventricular paced rhythm. QRS complexes are quite narrow due to both ventricles being paced in a synchronized fasion. About sarcoidosis: Sarcoidosis is a multisystem granulomatous disorder. Lung involvement is the typical p...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs