Bidirectional Ventricular Tachycardia Due to a Mixture of Focal Fascicular Firing and Reentry

Sarfraz A Durrani; Raphael Sung; Melvin Scheinman

doi:10.1016/j.ccep.2016.07.007

Bidirectional Ventricular Tachycardia Due to a Mixture of Focal Fascicular Firing and Reentry

Card Electrophysiol Clin. 2016 Dec;8(4):753-764. doi: 10.1016/j.ccep.2016.07.007.

Authors

Sarfraz A Durrani¹, Raphael Sung², Melvin Scheinman³

Affiliations

¹ MedStar Heart and Vascular Institute, #501 Hamaker court, Fairfax, VA 22031, USA. Electronic address: sarfraz.A.Durrani@medstar.net.
² Peninsula Primary Care, Cardiology, 30 Garden Court, Suite B, Monterey, CA 93940, USA.
³ University of California San Francisco Medical Center, 500 Parnassus Avenue, MUE 436, San Francisco, CA 94143-1354, USA.

PMID: 27837895
DOI: 10.1016/j.ccep.2016.07.007

Abstract

Bidirectional ventricular tachycardia (BDVT) is a well-known phenomenon since it was first described in 1922. Various mechanisms have been proposed for BDVT, including digitalis toxicity, hypokalemia, Anderson-Tawil syndrome, acute myocarditis, and catecholaminergic polymorphic ventricular tachycardia. It is characterized by rapid, wide complex electrocardiogram pattern with alternating QRS morphology and axis. The alternation of the QRS is usually right bundle branch block with 180° swings in the frontal plane axis or, less commonly, alternation of right bundle branch and left bundle branch forms. Most of the proposed mechanisms involve triggered activity or enhanced automaticity. We describe a unique BDVT, with characteristics of both re-entry and triggered activity, which terminated with a focal Rf lesion.

Keywords: Bidirectional ventricular tachycardia; Bundle branch reentry; Enhanced automaticity; Fascicular tachycardia.

Publication types

Case Reports
Review

MeSH terms

Aged
Bundle-Branch Block
Electrocardiography*
Heart Conduction System / physiopathology*
Humans
Hyperlipidemias
Male
Myocardial Ischemia
Tachycardia*

Supplementary concepts

Bidirectional tachycardia