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TRANSCRIPT
VT versus SVT with Aberration - Interpretation Cheat Sheet
visualmed.org
Features favouring VT
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RBBB
LBBB
Taller 2nd R wave (R’)
R’
R
V1
V6
V1
V6
Deep Swave
S
Broad, deepS wave
S
Broad, clumsyR wave
R
● Absence of typical RBBB or LBBB morphology● AV dissociation (P and QRS complexes occur independantly of each other)
P P PP
● Presence of captured beats (normal sinus beat that is captured between a VT run) and fusion beats (hybrid complex of normal sinus beat and a ventricular beat colision)
Narrow QRScomplexcaptured
beat‘fusion beat’hybrid QRSmorphology
‘fusion beat’hybrid QRSmorphology
Narrow QRScomplexcaptured
beat
● Positive or negative concordance in all precordial leads, i.e. leads V1-6 show entirely positive (R) or entirely negative (QS) complexes.
Example of positive concordance in VT
RBBB morph. criteria in VT
V1
V6
LBBB morph. criteria in VT
Monophasic RQR
(biphasic QRS)
R > R’(taller left rabbit ear)
R < S wave(R:S < 1)
QS or QR(dominant Q)
Monophasic R(No q, s or r’)
V1orV2
V6
Initial r > 30 ms Onset or r tonadir of S > 60 ms
Notcheddownstroke
Any q wave QS or QR
pattern
Axis suggesting VT
Rt superior axis(+ve aVR, -ve I, avF)
Left axis inpresence of RBBB
Right axis inpresence of LBBB
Brugada algorithm
1. Positive or negative concordance2. Onset of R to nadir (lowest point) of S > 100 ms in any V lead
3. AV dissociation4. Morphology criteria: both V1,V6 suggest VT
Vany VT SVT
if not
if not
if yes
if yes
Standard patterns
Ref. Arrhythmia & Electrophysiology Review 2013;2(1):23-9
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