LOGO Wide QRS tachycardia Ko Jum Suk, MD, PhD Wonkwang university school of medicine and hospital ECG description of tachycardia 1.Regular narrow QRS tachycardia 2.Irregular narrow QRS tachycardia 3.Regular wide QRS tachycardia 4.Irregular Wide QRS tachycardia Wonkwang university school of medicine and hospital Palpitation Wonkwang university school of medicine and hospital Palpitation : terminated by adenosine Adenosine Wonkwang university school of medicine and hospital Abnormal rhythm during TMT Wonkwang university school of medicine and hospital Palpitation with collapse Wonkwang university school of medicine and hospital Normal conduction system Wonkwang university school of medicine and hospital Possible mechanisms of narrow QRS tachycardia (1) Sinus tachycardia Atrial tachycardia Junctional tachycardia Atrial fibrillation Wonkwang university school of medicine and hospital Possible mechanisms of narrow QRS tachycardia (2) Atrial flutter AVNRT AVRT ILVT Wonkwang university school of medicine and hospital Possible mechanisms of wide QRS tachycardia Ventricular tachycardia SVT with aberrant conduction AF with preexcitation AVRT(antidromic tachycardia) Wonkwang university school of medicine and hospital Possible mechanisms of wide QRS tachycardia Ventricular tachycardia SVT with aberrant conduction AF with preexcitation AVRT(antidromic tachycardia) Wonkwang university school of medicine and hospital 28/F palpitation Wonkwang university school of medicine and hospital AV dissociation SAN A AVN V Wonkwang university school of medicine and hospital RFCA Wonkwang university school of medicine and hospital 87/M palpitation Wonkwang university school of medicine and hospital Fusion/Capture beat Wonkwang university school of medicine and hospital 35/F syncope Wonkwang university school of medicine and hospital TMT Wonkwang university school of medicine and hospital RVOT VT Wonkwang university school of medicine and hospital RVOT VT Wonkwang university school of medicine and hospital 43/M chest pain Wonkwang university school of medicine and hospital PCI Wonkwang university school of medicine and hospital Rhythm change after reperfusion Wonkwang university school of medicine and hospital VT or SVT? • Axis character – Rt. Sup. Axis (northwest axis, no man’s area), – RBBB c Lt axis deviation, LBBB c Rt. Axis deviation – Axis shift more than 40 degree Wonkwang university school of medicine and hospital 28/F palpitation Wonkwang university school of medicine and hospital Concordance Posterior Posterior V6 V6 V1 V1 Anterior Anterior Wonkwang university school of medicine and hospital Concordance Wonkwang university school of medicine and hospital Morphology Wonkwang university school of medicine and hospital 70/M palpitation Wonkwang university school of medicine and hospital Response to adenosine Wonkwang university school of medicine and hospital EPS : AVNRT with BBB Wonkwang university school of medicine and hospital 50/M palpitation * Wonkwang university school of medicine and hospital Response to adenosine Wonkwang university school of medicine and hospital Response to adenosine * Wonkwang university school of medicine and hospital After CTI block Wonkwang university school of medicine and hospital 28/F palpitation Wonkwang university school of medicine and hospital 68/M palpitation Wonkwang university school of medicine and hospital After cardioversion Wonkwang university school of medicine and hospital 65/M palpitation Wonkwang university school of medicine and hospital Adenosine Wonkwang university school of medicine and hospital Adenosine Wonkwang university school of medicine and hospital EPS : AVRT Wonkwang university school of medicine and hospital 60/M dyspnea, palpitation Wonkwang university school of medicine and hospital Telemetry Wonkwang university school of medicine and hospital ECG after cardiooversion Wonkwang university school of medicine and hospital PET scab Wonkwang university school of medicine and hospital Palpitation with collapse Wonkwang university school of medicine and hospital Electrical cardioversion Wonkwang university school of medicine and hospital ECG after cardioversion Wonkwang university school of medicine and hospital Confirmation and Tx of substrate Wonkwang university school of medicine and hospital Another case of irregular wide QRS tachycardia Wonkwang university school of medicine and hospital Palpitation Wonkwang university school of medicine and hospital Ashman phenomenon • Wide complex QRS complexes that follow a short R-R interval preceded by a long R-R interval • Represents an aberrantly conducted complex rat her than a complex that originates in ventricle • Refractory period of bundle branch is proportion al to the R-R interval of the preceding cycle Wonkwang university school of medicine and hospital 67/F syncope Wonkwang university school of medicine and hospital Telemetry Wonkwang university school of medicine and hospital Polymorphic VT 정의 : twisting of the points 크기가 다른 QRS군이 기선을 중심으로 회전하며 바뀌는 심실빈맥 QT prolongation(>500ms) : prolonged ventricular repolarization CAVB에 의한 bradycardia에서 발생할수 있음 Long QT Polymorphic VT Wonkwang university school of medicine and hospital 21/F SCD #01165849 Wonkwang university school of medicine and hospital Telemetry Wonkwang university school of medicine and hospital ECG after cardioversion Wonkwang university school of medicine and hospital ICD Wonkwang university school of medicine and hospital ECG F/U Wonkwang university school of medicine and hospital .