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Case Reports
. 2025 Jan 24;11(4):381-385.
doi: 10.1016/j.hrcr.2025.01.008. eCollection 2025 Apr.

An irregular wide QRS tachycardia

Batel Nissan  1 , Ayelet Shauer  1   2 , Ronen Durst  1   2 , David Luria  1   2 , Bernard Belhassen  1   3
Affiliations
Case Reports

An irregular wide QRS tachycardia

Batel Nissan et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Ablation; Cardiac tumor; Irregular tachycardia; Moderator band; Ventricular tachycardia.

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Conflict of interest statement

All authors declare having no potential conflict of interest.

Figures

Figure 1
Figure 1
A: Electrocardiogram (ECG) on hospital admission. An irregular rhythm ranging in rate from 80 to 200 beats/min and comprising multiple types of QRS is present. The most frequently observed QRS complexes have a left bundle branch block pattern with a left frontal plane axis. Note that the 5th QRS complex is a premature ventricular complex having a right QRS axis. B: Same ECG as A. Obvious sinus P waves (red arrow) and retrograde atrial activity (blue arrow) rule out the possibility of any atrial tachyarrhythmia to explain the irregular wide QRS tachycardia. The diagnosis of ventricular tachycardia is highly suggested because of the presence of sinus capture (red arrow) and fusion beats (red star) observed on the 3rd and 4th QRS complexes.
Figure 2
Figure 2
Lesions in the myocardium. Images were acquired on a Siemens Avanto 1.5T MRI System.A: Triple inversion T2 weighted spin echo demonstrating a bright lesion on the posterior aspect of the left ventricular muscle. B: Steady-state free precession 4-chamber image showing a small hypointense lesion in the septum adjacent to the moderator band. This is adjacent to the ablation site. C: Phase-sensitive inversion recovery delayed enhancement image of the lesion in A, demonstrating enhancement of a well-demarcated lesion in the inferior posterior to the left ventricle and the left atrium. D: Delayed enhancement as in B showing enhancement of the septal lesion.
Figure 3
Figure 3
Electrocardiogram (ECG) recorded 3 months earlier during a routine visit, at a time the patient was asymptomatic. No obvious anomaly is present except for a slightly negative T wave in V1 and V3.
Figure 4
Figure 4
Electrocardiogram (ECG) recorded 1 day after admission. The arrhythmia has markedly subsided, comprising now a few premature ventricular complexes having a left bundle branch block pattern and left axis deviation. Note the varying very long coupling intervals of the premature complexes. There are marked negative T waves in precordial and inferior ECG leads.
Figure 5
Figure 5
Carto Biosense 3D mapping system. Activation mapping of the right ventricle during the ventricular arrhythmia. Relatively wide earliest activation area (red) on apical right ventricular septum, because of multiple VT “exit points.”
See this image and copyright information in PMC

References

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    1. Gonzalez M.L., Sriram C.S., Gonzalez M.D. Irregular ventricular tachycardia originating from the moderator band. J Electrocardiol. 2023;78:25–28. - PubMed
    1. Chen M., Gu K., Yang B., et al. Idiopathic accelerated idioventricular rhythm or ventricular tachycardia originating from the right bundle branch: unusual type of ventricular arrhythmia. Circ Arrhythm Electrophysiol. 2014;7:1159–1167. - PubMed
    1. Sadek M.M., Benhayon D., Sureddi R., et al. Idiopathic ventricular arrhythmias originating from the moderator band: electrocardiographic characteristics and treatment by catheter ablation. Heart Rhythm. 2015;12:67–75. - PubMed
    1. Whitaker J., Batnyam U., Kapur S., Sauer W.H., Tedrow U. safety and efficacy of cryoablation for right ventricular moderator band-papillary muscle complex ventricular arrhythmias. JACC Clin Electrophysiol. 2022;8:857–868. - PubMed

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