Active myocardial ischaemia should be considered as a potential cause of bidirectional ventricular tachycardia, and Sgarbossa criteria can be utilized to identify ischaemia despite the wide complex rhythm.
BdVT is a distinct form of ventricular tachycardia, characterized by beat-to-beat alternation in QRS axis and morphology. BdVT in the context of acute ischaemia is rare and limited to case reports. Although this clinical presentation is exceptionally rare, in patients with BdVT and symptoms suggestive of acute coronary syndrome, active myocardial ischaemia should be considered as a potential underlying cause. This case highlights the utility of both the original and modified Sgarbossa criteria in identifying acute ischaemia in the setting of a wide complex rhythm.
Nossen et al. (2026) studied this question.