By Francis Morris; William Brady; A John Camm

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Indd 20 2/7/2008 11:59:27 AM Junctional Tachycardias The dominant R wave in lead V1 may be misinterpreted as right bundle branch block. In type B, the delta wave and QRS complex are predominantly negative in leads V1 and V2 and positive in the other precordial leads, resembling left bundle branch block. Mechanism of tachycardia formation Orthodromic atrioventricular re-entrant tachycardias account for most tachycardias in the Wolff-Parkinson-White syndrome. A premature atrial impulse is conducted down the atrioventricular node to the ventricles and then in a retrograde fashion via the accessory pathway back to the atria.

1 Appropriate discordance in uncomplicated left bundle branch block (note ST elevation in leads V1 to V3). indd 37 2/7/2008 12:01:42 PM 38 ABC of Clinical Electrocardiography Recognition of acute ischaemia Many different electrocardiographic criteria have been proposed for identifying acute infarction in left bundle branch block, but none has yet proved sufficiently sensitive to be useful in the acute setting. However, some features are specific indicators of acute ischaemia. ” Inappropriate concordance strongly indicates acute ischaemia.

1 Fascicular ventricular tachycardia (note the right bundle branch block pattern and left axis deviation). 2 Right ventricular outflow track tachycardia. 3 Torsades de pointes. Torsades de pointes is not usually sustained, but it will recur unless the underlying cause is corrected. Occasionally it may be prolonged or degenerate into ventricular fibrillation. It is associated with conditions that prolong the QT interval. Transient prolongation of the QT interval is often seen in the acute phase of myocardial infarction, and this may lead to torsades de pointes.

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ABC of clinical electrocardiography by Francis Morris; William Brady; A John Camm
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