A good example of why third degree heart block is so dangero | Figure 1

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A good example of why third degree heart block is so dangerous - it's propensity for inducing polymorphic VT. #VT #polymorphic #thirddegree #heartblock

Case 1

A 72 y/o woman presented to ED with palpitation. She had a history of left ventricular systolic dysfunction for the last 3 years. This is a wide complex tachycardia (WCT). In case of WCT, differential diagnosis should be made between ventricular tachycardia (VT), supraventricular tachycardia with aberrancy and Pre-excited tachycardia. The followings enabled us to diagnose VT.

Initial q wave >40 msec in aVR ( Vereckei aVR criteria for VT).
Right bundle branch block morphology in V1 and rS in V6 ( Brugada morphology criteria for VT). If this were a supraventricular tachycardia with a right bundle branch block aberrancy, then we would see "qRs" in V6, not rS! So this is VT in RBBB morphology! #cardiopaedia

Case 2

In relation to my previous VT pictures for the 88yo F

Additional Cases

following last case. Admitted with VT. Treatment with amiodarone and bètablockers! Now up for VT ablation!

dx? (Don't say VT. Don't say VT. ¡Don't say VT!)

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