Wide complex tachycardia electrophysiologic testing

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Differentiating VT from SVT with aberrant conduction

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

If the available 12 lead electrocardiograms, rhythm strips, and continuous electrocardiographic monitoring do not permit differentiation of ventricular tachycardia from supraventricular tachycardia with aberrant conduction as a cause of the wide complex tachycardia, then the performance of invasive electrophysiologic testing is a class I indication in the American Heart Association American college cardiology guidelines.

Invasive Electrophysiologic Testing

  • Induction of the wide complex tachycardia often requires burst pacing or premature stimulation at both varying cycle lengths and sites both with and without beta stimulation. While a wide complex tachycardia may be induced, it is critical to confirm that the morphology of the wide complex tachycardia and it's rate is identical to that that was observed in the clinical scenario that brought the patient to medical attention.[1]
  • It can be quite difficult to differentiate retrograde 1:1 VA activation during VT from an SVT, and a His bundle electrogram is very helpful in this regard.[1]

References

  1. 1.0 1.1 Lam P, Saba S (2002). "Approach to the evaluation and management of wide complex tachycardias". Indian Pacing and Electrophysiology Journal. 2 (4): 120–6. PMC 1557420. PMID 16951728. Retrieved 2013-08-04.

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