The study demonstrates that A-V dissociation is not required for the diagnosis of ventricular tachycardia and highlights the unreliability of contemporary ECG and bedside criteria for unequivocal diagnosis.
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Do not require A-V dissociation to diagnose VT; case report leaves open need for reliable ECG criteria.
Electrically induced ventricular and atrial tachycardias were observed in 12 cases, and ventriculoatrial (V-A) and atrioventricular (A-V) relationships were studied. It was noted that retrograde V-A conduction is a common phenomenon and that A-V dissociation is not a prerequisite for diagnosis of ventricular tachycardia. Conduction through the A-V node occurred readily in both antegrade and retrograde directions; and, all grades of block from first to complete and including the Wenckebach phenomenon were observed in both directions. The intensity of the first heart sound and the amplitude of the jugular a wave were governed directly by the temporal relationship between the P and the QRS regardless of whether conduction was antegrade, atrioventricular, or retrograde, ventriculoatrial. It is concluded that at present no electrocardiographic or bedside criteria are available for an unequivocal diagnosis of ventricular tachycardia and that further studies are needed.
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Massumi et al. (1967) studied this question.
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