Verapamil for ventricular tachycardia

Fascicular ventricular tachycardia (VT; also known as left VT) belongs to a subclass of idiopathic VTs. It can be confused with VT and supraventricular tachycardia. It is an entity well recognized by the cardiology community but not as frequently by emergency medicine physicians because of its infrequency. Idiopathic left VT was first described in 1979. Belhassen et al were the first to report on the characteristic termination of this VT with intravenous verapamil, hence accounting for the terms Belhassen VT and verapamil-responsive VT to describe the condition. We report on the cases of 2 patients who presented with complaints of palpitations. The first patient was incorrectly diagnosed with supraventricular tachycardia with aberrant conduction, whereas the second patient was correctly diagnosed with fascicular VT. Both cases were medically converted with verapamil. We also discuss the differentiation of ischemic VT and fascicular VT as well as the related therapeutic options and management approaches.