Right Ventricular Tachycardia

Abstract

A 46-year-old man presented to the emergency department with palpitation and chest pain with hemodynamically stable wide complex tachycardia of left bundle-branch block morphology (Figure 1). Electric cardioversion restored sinus rhythm after a trial of intravenous amiodarone (Figure 2A). Echocardiography demonstrated a normal left ventricle (LV); however, the right ventricle (RV) was dilated with contractile dysfunction and regional wall motion abnormalities (Movies I and II in the online-only Data Supplement).There were no valvular abnormalities in Doppler echo evaluation. The estimated pulmonary artery systolic pressure was 31 mm Hg from the tricuspid flow Doppler. The patient was referred for consideration for implantable defibrillator implantation with a diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) with monomorphic ventricular tachycardia (VT). Figure 1. Twelve-lead ECG of VT. VT had a morphology of LBBB with a leftward axis. LBBB indicates left bundle-branch block; and VT, ventricular tachycardia. Figure 2. A , Postcardioversion 12-lead ECG. B , ECG during initial hospitalization with diagnosis of myopericarditis. Subtle ST-segment elevations seen in inferior leads (arrows). Minimal ST-segment depressions seen in leads I and aVL (broken arrows). The cardiac biomarkers were elevated with a creatinine kinase level of 401 U/L (reference value, <225 U/L), and cardiac troponin T levels were 0.6 μg/L (reference value, <0.04 μg/L). These abnormal results were thought to be attributable to a combination of various factors such as the arrhythmia, electric cardioversion, and a …