The Significance of rS Change in the V2 Lead for Diagnosing Ventricular Tachycardia Deserves Attention: A Case Report

Abstract

Abstract. Occasionally, incessant ventricular tachycardia (VT) exhibits a narrow QRS complex pattern that could be misdiagnosed as supraventricular tachycardia. In this case, a 66-year-old woman was referred to the emergency department due to the worsen hemodynamic and incessant VT manifesting as a narrow QRS complex pattern that was initially misdiagnosed as supraventricular tachycardia, which was unresponsive to antiarrhythmic drugs. The electrocardiogram manifestation of VT was characterized by an rS configuration in lead V2 with Rs pattern in leads V1 and V3, and the R-wave amplitude of lead V1 and V3 was greater than that of lead V2, which was different from the typical electrocardiogram features of right bundle branch block. The patient was subsequently found to have suspected acute myocarditis when the cause of the disease was investigated. A combination of high-dose methylprednisolone, immunoglobulin and intra-aortic balloon pump was given immediately. Hemodynamics gradually stabilized, and ventricular tachycardia did not recur. The rS change in the V2 lead may be helpful to distinguish VT from supraventricular tachycardia.