Ventricular Tachycardia, or Accelerated Junctional Rhythm?

To the Editor. —The article Ventricular Tachycardia in Acute Rheumatic Fever by Freed et al 1 discusses the fact that malignant ventricular arrhythmias have not been described in association with acute rheumatic fever. The authors describe a patient who is thought to have paroxysmal ventricular tachycardia. The figures published are much more consistent with an accelerated junctional rhythm with abberation, sometimes called an accelerated idioventricular rhythm or nonparoxysmal junctional tachycardia. This arrhythmia has an entirely different mechanism (enhanced atrioventricular junctional automaticity) as well as a much more benign prognosis, and it is common in acute rheumatic fever. 2 The accelerated junctional rhythm is characterized by moderate acceleration of the rate above the sinus rate and onset and termination with intermediate or fusion beats, and it is frequently found in abnormalities where the pathologic process involves the atrioventricular node. This abnormality is characteristic of acute rheumatic carditis. The benign course in