Alternans during fascicular ventricular tachycardia due to digitalis toxicity

This report describes a digitalis-induced regular fascicular ventricular tachycardia characterized by marked QRS alternans a manifestation not usually associated with this arrhythmia. The striking alternation of QRS configuration suggested alternating ventricular activation from either a single focu...

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Bibliographic Details
Published in:Journal of electrocardiology 2018-05, Vol.51 (3), p.450-451
Main Author: Serge Barold, S.
Format: Article
Language:English
Subjects:
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy
Bundle of His - physiopathology
Cardiac arrhythmia
Digitalis - poisoning
Digitalis toxicity
Drug Therapy, Combination
Electrocardiography
Fascicular ventricular tachycardia
Female
Heart failure
Humans
Immunoglobulin Fab Fragments - therapeutic use
Lidocaine - therapeutic use
Medical diagnosis
Middle Aged
Tachycardia, Ventricular - chemically induced
Tachycardia, Ventricular - drug therapy
Tachycardia, Ventricular - physiopathology
Toxicity
Ventricular alternans
Ventricular tachycardia
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Summary:This report describes a digitalis-induced regular fascicular ventricular tachycardia characterized by marked QRS alternans a manifestation not usually associated with this arrhythmia. The striking alternation of QRS configuration suggested alternating ventricular activation from either a single focus with two exits in distal branches of the left anterior fascicle or 2 different foci localized in the Purkinje-myocardial network of the left anterior fascicle. •Digitalis toxicity caused fascicular ventricular tachycardia (VT) associated with QRS alternans.•Fascicular VT with alternans appeared to originate either for one focus with two exits in the His-Purkinje system or less likely from two foci at slightly different rates from separate parts of the left anterior fascicle.•Despite the prevalent belief that that fascicular ventricular tachycardia is a common manifestation of digitalis toxicity, the literature suggests that the arrhythmia is quite rare in this setting especially in association with QRS alternans.
ISSN:0022-0736
1532-8430
DOI:10.1016/j.jelectrocard.2018.01.011