Shortfalls for exact identification of endocardial source of arrhythmia on Surface ECG

A 50 years old female with normal angiography and normal Echo ,with recurrent tachycardia, came to emergency in cardiac Hospital,patient reverted to sinus rhythm with sedation, lignocaine and magnesium sulphate,normal troponin and electrolytes ,Cardiac MR dome last year was also normal ,what should be best management plan for this ?

What is the location of this tachycardia or VT?

Is ablation possible for this patient as she doesn't tolerate this rhythm well?

Few things seems to be eye catching but keeping in mind that surface ecg being only 12 leads has lots & lots of shortfalls for exact identification of endocardial source of arrhythmia ! Hence as you know , as the EP catheters are multipolars so much much more helpful in pin pointing the exact endocardial source of arrhythmias

1. The arrhythmias seem to be Ventricular driven

2. ⁠morphologically , it’s seems mono morphic rather than polymorphic , hence supporting a single focus

3. ⁠the shortest way to further dissect this would be to look for / find out the Hard evidence / or pathognomonic VA dissociation !!!!

4. ⁠unfortunately not all tracings will this evidence as because

A. ECG being a snap short of few seconds , it’s possible that at that exact time it’s not behaving in dissociated Manner

B. Secondly lot many humans have no retrograde conduction , hence VA dissociation May not be seeable

5. Once it’s proven or otherwise , for ablation you further need to calculate axis from limb leads only to know or be able to identify the exit site of arrhythmia( the sweet spot for ablation )

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