Methods of diagnosis of ventricular tachycardia. QRS complex tachycardia with more than 0.12

The possibilities of other methods electrocardiological: previously mentioned the use of Holter monitoring, stress tests and intracavitary programmed electrophysiological studies for ventricular tachycardia study. However, the true testimony to the EPE in a patient with ventricular tachycardia is controversial.

Most authors, including the Committee of NASPE, believe that the EPS should not be performed during unstable ventricular tachycardia, especially if it is asymptomatic and the patient do not have heart disease. According to many authors, EPS and pharmacological tests for the selection of the most effective therapy (ie, a drug that prevents imposed tachycardia) should be performed in patients with:

a) with sustained ventricular tachycardia;
b) with sustained tachycardia and decompensated hemodynamic disturbances;
c) with ventricular tachycardia resistant to therapeutic treatment, especially in patients with heart disease.
However, there are still doubts as to whether it is the best scheme, and there are many differences between the results of clinical tests and elektrofarmakologicheskih reaction. NASPE Committee recommends that EPS in patients with ventricular tachycardia in patients with heart failure in the community, as well as in patients with syncope. More recently, Wellens, Brugada and Stevenson studied the relationship between ventricular arrhythmias and hyperactive, and EPS reached the following conclusion:

a) the value of an unstable ventricular tachycardia is not known;
b) Commencement of polymorphic ventricular tachycardia during EPS is not a specific feature;
c) during the EPS ventricular fibrillation can occur in patients with heart disease or not. The frequency of this disorder is similar to that observed in patients after myocardial infarction with significant ventricular arrhythmias or without them, as well as in patients after sudden cardiac arrest;
d) the occurrence of sustained ventricular tachycardia in postinfarction patients does not mean that they are at high risk of sudden death in contrast to what is stated in Sec. 3 and 10. Other authors are of the same opinion;
d) In terms of therapy, has a value of preventing the occurrence of sustained ventricular tachycardia after administration of the drug, but the stability of the arrhythmia after antiarrhythmic treatment does not preclude the clinical use of this drug.

Methods of diagnosis of ventricular tachycardia. QRS complex tachycardia with more than 0.12

QRS complex tachycardia with more than 0.12

These types of tachycardia occur infrequently. Tachycardia occurs. beams (the trunk, right leg, left leg or the trunk of the two beams), so called beam tachycardia. According Elisari, Munoy et al., There may be a pattern of ventricular blockade of I degree, in particular the blockade of right bundle branch block in combination with or without gemiblokom and ECG pattern of isolated gemibloka. QRS complex tachycardia at some of the beam can be up to 0.13. AQRS strongly rejected by the left or right, and HV interval is short or negative. AV dissociation occurs frequently, there may be pulses of capture or drain systems.

Differential diagnosis of supraventricular tachycardia or atrial flutter with some aberrant difficult with a single surface ECG, because the blockade of the right bundle branch block I degree may be the result of aberrant or momentum generated in the upper part of the intraventricular conducting system (in the branching left bundle branch block in the case), and gives a similar picture. The following signs may help in diagnosis:

a) a drain complexes suggests the emergence of ventricular tachycardia;
b) signs AB dissociation strongly suggest ventricular tachycardia. Active fibrillation should be carefully studied, it is often difficult to do using the surface ECG;

c) if there is no pattern of ventricular conduction disorders of I degree in sinus rhythm, it is likely that there is a beam ventricular tachycardia, supraventricular tachycardia, but not with an aberrant, since aberrant supraventricular tachycardia is usually represented by a picture of complete ventricular block (QRS complex more than 0,12 c). The problem is that the ECG sinus rhythm is often missing. However, it should be remembered that in paroxysmal reentry nodal tachycardia circuit intranodalnym prong P1 often (30%) occurs after the complex QRS, although it is close by reminding the blockade of right bundle branch block I degree (prong r 'in lead V1 and / or II, III, aVF). If a picture is reminiscent of an aberrant pattern of tachycardia blockade of the right bundle branch block first degree, you should consider this possibility;
d) electrophysiological signs of retrograde aktivaschii bundle branch block.

According to some authors, such arrhythmias are often poorly tolerated. Forecast is similar to that seen with classical ventricular tachycardia.