Bidirectional ventricular tachycardia due to coronary allograft vasculopathy a unique presentation

Abstract

Bidirectional ventricular tachycardia (BVT) is an uncommon type of polymorphic ventricular tachycardia (PVT) with alternating polarity of the QRS complex most commonly described digitalis toxicity. Recent data has demonstrated the possible molecular basis of this electrocardiographic phenomenon. To our knowledge this is the first reported case of BVT in a patient with orthotopic cardiac transplantation and coronary allograft vasculopathy.

Figure 1

Note the variable coupling intervals () (CI) between sinus and left bundle/inferior axis beats (400, 320, 350, 360 ms.) while the CI between the left and right bundle morphology beats () is constant (440 ms).

Figure 2

Note the variable CI () between sinus and left bundle beats (360, 400 ms); and the constant CI between the alternating left and right bundle beats during VT (440/400 ms).