Long VT

→ Figure 1

→ Figure 2

Your turn

Why does it take so long (over 15 seconds) for the ATP to be delivered?

1. VT majority has been increased from 6/8 to 30/40.
2. Persistence has been increased to 50 cycles
3. The VT self-terminates and than starts up again, delaying the diagnosis.
4. There has been wrongful labelling of the episode as supraventricular arrhythmia, thereby delaying the therapy.

Interval plot

The episode begins with an elevated heart rate at around 110 beats per minute. There are multiple ventricular events with a shorter cycle, suggesting the existence of PVCs. There is a sudden acceleration of the ventricular rhythm into the VF zone but the arrhythmia stabilizes in the VT zone. After a period of 15 seconds of stable VT in the VT zone, an ATP is delivered, which terminates the arrhythmia. The last marker indicates filling of the “Slow Rhythm” majority, which means the end of the episode.

1. At the beginning of the episode we see atrial pacing at 100-110/min with preserved atrioventricular conduction.
2. Suddenly there are rapid ventricular events which fill the VF counter, marker VF (11)
3. The ventricular events slow down and the VT counter is filled shortly after.
4. At this marker, VTLC (12), the persistence counter steadily increases with each ventricular event.
5. When the persistence counter is filled (50) after 15 seconds, an ATP is delivered
6. The ATP terminates the VT

→ Figure 3

Correct answer = n° 2