This 66-year-old man with a 20 year history of coronary artery disease and ventricular arrhythmias had an ICD implanted 14 years ago. He is seen for a reassessment in the ICD clinic:

Ventricular tachycardia, 112/ min

Comment: This ECG meets many Brugada criteria for VT. Although AV dissociation is not easily evident, criteria for VT include:

1. Right superior axis
2. R wave over 40ms in lead V1
3. Onset of R to Nadir of S > 100ms in precordial leads (eg: lead V2)
4. Precordial leads do not meet criteria for either LBBB or RBBB

The arrhythmia is treated with anti-tachycardia pacing (ATP) through the defibrillator. The patient is admitted to hospital for further assessment and treatment.

• Sinus bradycardia, 57/min
• Left bundle branch block