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A case of intra-ventricular dissociation with dual ventricular tachycardia Yukitaka Shizukuda 1 , Kazufumi Tsuchihashi 1 , Hitoko Ogata 1 , Nobuichi Hikita 1 , Fujito Kamei 1 , Shuji Yonekura 1 , Akira Hashimoto 1 , Shigemichi Tanaka 1 , Yuichi Hamagami 2 , Osamu Iimura 1 1The Second Department of Internal Medicine, Sapporo Medical College 2Nishiki Machi Clinic pp.579-583
Published Date 1989/5/15
DOI https://doi.org/10.11477/mf.1404205485
  • Abstract
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A 63 years old woman with chronic heart failurewas admitted to our hospital for palpitation attack on 26th Apr 1988. The patient was died by cardio-genic shock and recurrent ventricular fibrillation 12 hours after admission. The autopsy revealed diffuse myocardial fibrosis and disarray which was compa-tible with dilated cardiomyopathy.

The electrocardiogram on admission showed a peculiar wide QRS tachycadia with atrioventricular dissociation. After intravenous injection of 400 mg of procainamide, the QRS was separated into two types. The one type was left bundle branch blook (LBBB) type with right axis deviation (type A), which was similar as that documented on Jan 1985, and the other was LBBB with normal axis (type B). Each wide QRS tachycardias were sustained indepen-dently and simultaneously either with RR 440 msec. or with RR 600 msec as if they were dissociated intraventricularly. The different wide QRS tachy-cardia documented on Feb 1986 was suspected as the fusion beats with type A and the QRS resembling type B.

Although ventricular tachycardia with beat-to-beat changes of ORS morphology was generally regarded as bidirectional tachycardia, double foci were con-sidered as origins of the two types of wide QRS tachycardia simultaneously observed in this patient.


Copyright © 1989, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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