Key result
Vectorcardiography successfully aided in diagnosing a wide complex tachycardia as supraventricular tachycardia with aberrancy by demonstrating fast initial activation in the QRS loop.
Why the study?
Reaching the correct diagnosis when dealing with wide complex tachycardia is critically important, leading to the use of vectorcardiography to further define ventricular activation patterns.
Case Report (n=1)
Vectorcardiography may serve as a useful adjunctive diagnostic tool for differentiating the origin of wide complex tachycardia.
ECG criteria may aid SVT diagnosis in LVNC-related WCT; leaves open need for invasive confirmation before changing practice.
A 69-year-old woman with a history of hypertension and obesity, hospitalized with atypical chest pain, was diagnosed with left ventricular noncompaction. In-hospital monitoring of the cardiac rhythm revealed multiple episodes of atrial tachycardia and one episode of wide complex tachycardia (WCT) with left bundle branch block-like morphology and a right superior QRS axis. The electrocardiographic criteria were suggestive of a supraventricular origin of the WCT. Given the importance of reaching the correct diagnosis when dealing with a WCT, we tried to further define the pattern of ventricular activation using vectorcardiography (VCG). We analyzed the QRS loops during WCT in comparison to a sinus beat, a narrow complex tachycardia beat, and a premature ventricular contraction. The fast initial activation seen in the efferent limb of the QRS loop during the WCT was thought to be reflective of the fast initial activation via the conduction system seen in SVT with aberrancy, which was our final diagnosis for the WCT episode. This case illustrates a novel use of vectorcardiography as an additional diagnostic tool in the differential diagnosis of WCT.
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Țentea et al. (2021) conducted a case report in Left ventricular noncompaction with wide complex tachycardia (n=1). Vectorcardiography vs. Electrocardiography was evaluated on Differential diagnosis of wide complex tachycardia. Vectorcardiography successfully aided in diagnosing a wide complex tachycardia as supraventricular tachycardia with aberrancy by demonstrating fast initial activation in the QRS loop.
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