Ventricular premature complexes (VPC) in couplets
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Ventricular premature complexes (VPC) are seen as wide bizarre QRS complexes without preceding P waves and followed by a compensatory pause which compensates for their prematurity. A couplet means two consecutive ventricular ectopic beats with no intervening sinus beat. Couplets and triplets (also called salvos) may be the fore runner of ventricular tachycardia. If the ventricular tachycardia less than 30 seconds, it is called non sustained ventricular tachycardia (NSVT), while those which last longer or require earlier cardioversion due to hemodynamic compromise are called sustained ventricular tachycardia. The ventricular ectopic beats in this ECG have a right bundle branch block pattern suggesting a left ventricular origin. The VPCs in inferior leads have more than 2 notches and will qualify for the description of fragmented VPC or f-VPC. Fragmented QRS is thought to signify a myocardial scar as per some reports.