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. 2024 Apr 8;26(4):euae049. doi: 10.1093/europace/euae049

Table 6.

Twelve-lead ECG during VT

ECG during VT Description Suggestive cause of ES/site of origin
TdP PVT with ‘QRS twisting' Acquired or congenital LQT
PVT VT with continually changing QRS morphology Acute ischaemia, primary electrical disease (BrS, SQT, IVF, CPVT, ERS)
Bidirectional VT Alternating QRS morphology (beat-to-beat) CPVT, digitalis intoxication, Andersen–Tawil syndrome
LBBB-like and inferior axisa ARVC, idiopathic VT from the RVOT (normal heart)
RBBB-like VT with left superior axis (LAH-like, less frequently right inferior axis LPH-likea)83 Narrow QRS (100–140 ms), short RS interval (onset of R wave to nadir of S wave of 60–80 ms), r < R′ in V1 Left ventricular fascicular VT (usually normal heart)
QRS broad (≥150 ms), absence of rsR′ in V1 Papillary muscle VT
QRS broad (≥155 ms), R ≥ s in V5, may be positive QRS concordance Peri-mitral VT
Fast (>200 b.p.m.) LBBB-like VT, with rapid downstroke of S wave in the anterior precordial leads, QRS during sinus rhythm (usually broad) may be identical to QRS duringa VT84,85 Short QRS onset—the R-wave peak time (R-wave peak time) and fast downstroke of S wave in V1–V2 Bundle branch re-entrant tachycardia (SHD)
RBBB-like VT with pseudo-delta wave and broad RS interval,4 absence of q waves in inferior leads and presence in Leada I86–88 Pseudo-delta wave ≥34 ms (interval from the earliest ventricular activation to the earliest fast deflection in any precordial lead)
R-wave peak time in V2 ≥85 ms
Shortest RS complex ≥121 ms (in any precordial lead)
VT with epicardial origin (SHD)

aLBBB-like pattern is characterized by a negative net amplitude of QRS complexes in leads V1 and/or V2 and RBBB-like by a positive net QRS amplitude in these leads.

ARVC, arrhythmogenic right ventricular cardiomyopathy; BrS, Brugada syndrome; CPVT, catecholaminergic polymorphic ventricular tachycardia; ECG, electrocardiogram; ES, electrical storm; ERS, early repolarization syndrome; IVF, idiopathic ventricular fibrillation; LAH, left anterior hemiblock; LBBB, left bundle branch block; LPH, left posterior hemiblock; LQT, long QT; PVT, polymorphic ventricular tachycardia; RBBB, right bundle branch block; RVOT, right ventricular outflow tract; SHD, structural heart disease; SQT, short QT; TdP, torsade de pointes; VT, ventricular tachycardia.