Fascicular ventricular tachycardia: an uncommon but distinctive form of ventricular tachycardia

Emergency physicians often encounter wide-QRS-complex tachyarrhythmias, which pose both a diagnostic and therapeutic challenge. Most such rhythms are the result of ventricular tachycardia (VT) related to coronary artery disease. However, the spectrum of VT is broad, with several distinct clinical entities, some of which are benign in their clinical course. Idiopathic fascicular VT is one such entity. We present two cases of idiopathic fascicular VT and discuss the unique electrocardiographic, electrophysiologic, and electropharmacologic properties that make it an identifiable and treatable arrhythmia in the ED.