International Journal of Cardiology 184 (2015) 391–393

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International Journal of Cardiology

journal homepage: www.elsevier.com/locate/ijcard

Letter to the Editor

VT or not VT: That is the question

Natale Daniele Brunetti a,⁎, Luisa De Gennaro b, Francesco Santoro a, Andrea Igoren Guaricci a, Matteo Di Biase a
a
Cardiology Department, University of Foggia, Italy
b
Cardiology Department, Ospedale S. Paolo, Bari, Italy

a r t i c l e i n f o A 47-year-old woman, obese, was evaluated in the emergency

department after experiencing 1 h of rapid heart beat, accompanied
Article history:
by mild dyspnea, chest pain and dizziness. Her past medical history
Received 10 January 2015
Accepted 21 February 2015
included hyperlipidemia, which was treated with atorvastatin 20 mg,
Available online 24 February 2015 and hypertension, for which she was prescribed olmesartan 20 mg.
The patient appeared not uncomfortable sitting in chair with a blood
Keywords: pressure of 110/70 mm Hg, however with a weak radial pulse, and an
Ventricular tachycardia
otherwise unremarkable physical examination. The patient's initial
Supraventricular tachycardia
Wide QRS tachycardia electrocardiogram showed a wide complex tachycardia at a rate of
Amiodarone 200 beats per minute, with a QRS width of approximately 140 msec.
The key question: was this is a supraventricular tachycardia with left
bundle branch block or indeed a ventricular tachycardia?

Fig. 1. Admission electrocardiogram showing wide-QRS tachycardia (N200 bpm). RS complexes in all precodial leads and a time from the onset of the R wave to the nadir of the S wave
shorter than 100 msec can be observed.

⁎ Corresponding author at: Department of Medical & Surgical Sciences, University of Foggia, Viale Pinto 1, 71100 Foggia, Italy.
E-mail address: natale.brunetti@unifg.it (N.D. Brunetti).

http://dx.doi.org/10.1016/j.ijcard.2015.02.067
0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
392 N.D. Brunetti et al. / International Journal of Cardiology 184 (2015) 391–393

Fig. 2. Electrocardiogram after amiodarone infusion showing sinus tachycardia and unchanged QRS aspect.

According to Brugada criteria [1], ventricular rhythm was regu-
lar, “RS complex” was present in almost all precordial leads, the
time from the onset of the R wave to the nadir of the S wave was
shorter than 100 msec in any lead with an RS complex, and no sign
of atrio-ventricular dissociation was observable (Fig. 1): a diagno-
sis of supra-ventricular tachycardia with bundle branch block was
therefore possible.
In spite of this, QRS morphology was not typical of bundle
branch block in V6 lead and ventricular rate was very fast
(N 200 bpm).
Nevertheless, the tachycardia was extremely well tolerated by the
patient, which had excellent hemodynamics, despite her very fast
wide-QRS tachycardia.
A more accurate interview revealed a history of atrial flutter
previously treated with catheter ablation. Amiodarone infusion
(5 mg/kg over 1 h) was therefore started: few minutes later, tachy-
cardia suddenly stopped and electrocardiogram showed sinus
tachycardia with unchanged QRS aspect (Fig. 2). A final diagnosis
of supra-ventricular tachycardia was done: the woman was hospi-
talized for further electrophysiology study and possible catheter

Fig. 3. Electrocardiogram 12 h after admission showing sinus rhythm and left bundle branch block.
 N.D. Brunetti et al. / International Journal of Cardiology 184 (2015) 391–393 393

ablation. A third electrocardiogram recorded 12 h after admission Reference

showed sinus rhythm and left bundle branch block (Fig. 3). Changes
[1] P. Brugada, J. Brugada, L. Mont, J. Smeets, E.W. Andries, A new approach to the differential
in V6 lead aspect may presumably explained by different positions of diagnosis of a regular tachycardia with a wide QRS complex, Circulation 83 (1991)
electrocardiogram registration (sitting on the bed in first two electrocar- 1649–1659.
diograms, resting in the bed in the last).

Conflict of interest

Authors have no potential conflict of interest to disclose.