Thread by @InbarRaber

🫀For all the cardiology fellows starting call, I wanted to share this #ECGchallenge published in @JACCJournals #JACCCaseReports #tweetorial
27-year-old woman presented with palpitations. What does her ECG show?

Answer choices:

✅ The answer is C) outflow tract VT
➡️The differential diagnosis for a wide complex tachycardia includes VT, SVT with aberrancy (answer choice A) and SVT with pre-excitation

➡️The ECG shows 3:1 VA conduction. VA dissociation or VA conduction with variable block favors VT over SVT. Also the >60 ms from the onset of the QRS to the nadir of the S-wave in V1 and V2 also favors VT. The LBBB pattern w inferior axis localizes the VT to the outflow tract

➡️Outflow tract VT is idiopathic, caused by cAMP triggered activity which can occur in healthy individuals. It can be terminated with adenosine. Long term treatment of RVOT VT can be deferred if the patient is asymptomatic, though ablation or nodal agents can also be initiated.

➡️Fascicular VT (answer choice D) is another type of idiopathic VT. Its typical pattern is a RBBB with superior axis (left posterior fascicle) or inferior axis (left anterior fascicle). The first line treatment for fascicular VT is verapamil.

➡️Moderator band VT (answer choice B) arises from the moderator band and typically has LBBB morphology with a superior axis. Moderator band VT can instigate VF and is often treated with anti arrhythmic agents or ablation.

Thank you to #JACCCaseReports editor Dr @JGrapsa and guest editor Dr Antonio Sorgente for creating the ECG challenge opportunity. 😊 And to co-authors @jasonmatosmd and Dr Al Buxton for your tremendous ECG teaching and mentorship @BIDMCVFellows #meded #EPeeps

Here is the link to our ECG challenge article:
jacc.org/doi/10.1016/j.… Also loved reading the commentary from Dr Antonio Sorgente about his experience discussing ECGs as a fellow at @BidmcCvi - the tradition continues!
jacc.org/doi/10.1016/j.…