Ventricular tachycardia with QRS configuration similar to that in sinus rhythm and a myocardial origin: differential diagnosis with bundle branch reentry

Abstract

A unique form of ventricular tachycardia is described. The QRS complex morphology on the 12-lead ECG during tachycardia was grossly similar to that during sinus rhythm. The His bundle activation was passive and occurred with a long activation time from the ventricle to the His bundle. Although it mimics usual bundle branch reentry, this form of ventricular tachycardia appears to be due to a different mechanism in which the His bundle is not obligatory for the continuation of the reentrant phenomenon.

Different Forms of Ventricular Tachycardia Involving the Left Anterior Fascicle in Nonischemic Cardiomyopathy: Critical Sites of the Reentrant Circuit in Low‐Voltage Areas

“…Guo et al . have previously described VT reentrant circuits that include part of the Purkinje system and some ventricular myocardium but not the His bundle and, thus, His bundle activation was not needed for tachycardia perpetuation 9 . In our study, involvement of both left bundle fascicles was suspected in the reentrant circuit of 2 patients.…”

A Technique for the Rapid Diagnosis of Wide Complex Tachycardia with 1:1 AV Relationship in the Electrophysiology Laboratory

“…1). The maneuver is especially useful when VT may be activating the ventricular myocardium from a site near an AP, as in patient 1, near a diseased His Purkinje system, 13 or in cases of bundle branch reentry where pacing the atrium can result in a QRS morphology that is similar to the reentrant VT 14 …”

Tachycardia with QRS Morphology Identical to the Normal Sinus Rhythm Electrocardiogram: What is the Mechanism?

“…The differential diagnosis of this tachycardia includes: (1) Supraventricular tachycardia with native LBBB conduction, (2) Bundle Branch Re‐Entrant Venticular Tachycardia (BBRVT), or (3) Intramyocardial VT with a proximal exit site near or including the normal Purkinje exit site 1 . Supraventricular tachycardia with preexisting LBBB was felt to be unlikely due to the presence of a 2:1 VA relationship during tachycardia.…”

“…Intramyocardial VT could be easily ruled out by the fact that changes in the His‐His interval preceded changes in the ventricular cycle length. During intramyocardial VT with passive activation of the His‐Purkinje system the opposite is true 1 …”