[A case of intra-ventricular dissociation with dual ventricular tachycardia]

A 63 year old woman with chronic heart failure was admitted to our hospital for palpitation attack on 26th Apr 1988. The patient was died by cardiogenic shock and recurrent ventricular fibrillation 12-hours after admission. The autopsy revealed diffuse myocardial fibrosis and disarray which was compatible with dilated cardiomyopathy. The electrocardiogram on admission showed a peculiar wide QRS tachycardia with atrioventricular dissociation. After intravenous injection of 400 mg of procainamide, the QRS was separated into two types. The one type was left bundle branch block (LBBB) type with right axis deviation (type A), which was similar as that documented on Jan 1985, and the other was LBBB with normal axis (type B). Each wide QRS tachycardias were sustained independently and simultaneously either with RR 440 msec. or with RR 600 msec as if they were dissociated intraventricularly. The different wide QRS tachycardia documented on Feb 1986 was suspected as the fusion beats with type A and the QRS resembling type B. Although ventricular tachycardia with beat-to-beat changes of QRS morphology was generally regarded as bidirectional tachycardia, double foci were considered as origins of the two types of wide QRS tachycardia simultaneously observed in this patient.