Voir la suite de cet article sur Cursus ECG
Patient
64-year-old man with a prior history of extensive anterior infarction; altered left ventricular ejection fraction (38%); ECG monitoring;
Trace
Sinus rhythm (positive P wave in leads I, II and negative in aVR); left atrial enlargement (large P wave, bifid and fragmented pattern in leads II, III, aVF, V5, V6, widened negative component of the P wave in V1); normal PR; narrow QRS with sequela of extensive anterior necrosis (q wave in leads I, aVL, V6 and poor R wave progression from V1 to V4); premature ventricular complexes arising from the left ventricle: premature ventricular activity (at the end of the preceding T wave) featuring wide QRS (QRS > 160 ms), with right delay (positive QRS in V1 and negative in V6), extreme-right axis (negative QRS in lead I and in the inferior territory) suggesting a left ventricular origin, fragmented pattern (suggesting an underlying cardiac disease); presence of an atrial activity in the T wave following the premature beat probably of sinus origin and not retrograde (morphology identical to the sinus activity, positive in leads I, II and negative in aVR, with a maintained fixed PP cycle);
Exergue
The search for causal heart disease is an essential component of the management of patients with premature ventricular complexes. The analysis of the pattern of QRS complexes of sinus origin allows evoking the presence of a sequela of ischemic necrosis, a left or right ventricular hypertrophy, signs of arrhythmogenic right ventricular dysplasia, etc.
A premature ventricular complex corresponds to premature excitation from the ventricular myocardium or ventricular conduction tissue from a point below the bifurcation of the right and left bundle branches.