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Patient
37-year-old woman with no prior history; performing of an electrocardiogram for palpitations;
Trace
Sinus rhythm (positive P wave in leads I, II and negative in aVR); normal PR (190 ms); narrow QRS with left anterior fascicular block (left axis with poor R wave progression from VI to V4); trigeminal premature ventricular complexes with alternation between two conductive QRS and a premature beat; probably benign, premature complexes from the right infundibulum: relatively narrow complexes, non-fragmented, with left delay (negative in V1 and positive in V6), transition in V4 (delayed, suggestive of a right ventricular origin) and infundibular "arrow-like” pattern (high amplitude with positive deflection in the inferior leads); retrograde atrial conduction (negative P’ waves inferiorly) with post-extrasystolic sinus pause;
Exergue
Benign right ventricular premature beats occurring in a healthy heart, are monomorphic, tall, unnotched and very little widened, with a long and fixed coupling interval, a left delay pattern and a descending vertical axis originating from the right ventricular outflow tract. The remainder of the electrocardiogram should also be within normal ranges without signs of arrhythmogenic right ventricular dysplasia.
The pattern found on this electrocardiogram corresponds to benign right ventricular premature complexes. They occur in patients without underlying cardiac disease or metabolic abnormalities and in the absence of a specific territory of predilection.