Wide complex tachycardias examples

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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

There are several EKG criteria that may help differentiate ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrancy in the patient with a wide complex tachycardia. The diagnosis of VT is more likely if the electrical axis is -90 to -180 degrees (a “northwest” or “superior” axis), if the QRS is > 140 msec, if there is AV dissociation, if there are positive or negative QRS complexes in all the precordial leads, and if the morphology of the QRS complexes resembles that of a previous premature ventricular contraction (PVC).

EKG Examples

Shown below is an EKG demonstrating VT with right bundle branch block.

VT with RBBB morphology.jpg

Copyleft images obtained courtesy of ECGpedia.[1]


Shown below is an EKG demonstrating sinus tachycardia and WPW which mimics VT.

WPW with sinus tachycardia mimicking VT.jpg

Interpretation of the Previous ECG

Rhythm

Rate

  • Use the 'count the squares' method (a bit less than 3 large squares ~> 300-150-100), thus about 110 bpm and thus sinustachycardia.

Conduction (PQ,QRS,QT)

  • PQ-interval=0.10sec (2.5 small squares), QRS duration=0.10sec, QT interval=320ms

Axis

  • The EKG depicts a horizontal normal heart axis as there are positive deflections in leads I and II and negative deflections in leads III and AVF.

P wave morphology

  • The P wave is rather large in II, but does not fulfill the criteria for right atrial dilatation.

QRS morphology

ST morphology


Shown below is an EKG demonstrating wide complex tachycardia at a rate of 160/min with a RBBB, AV dissociation, and extreme right axis deviation as both leads I and aVF are directed downwards. These findings favor VT.

Wide complex tachycardia 1.jpg

Shown below is an EKG of the same patient after 7.5 mg verapamil was administered, which slowed the VT and caused the AV dissociation to become more apparent.

Wide complex rhythm with AV dissociation.jpg

Shown below is an EKG of the same patient who ultimately converted to sinus rhythm.

Wide complex rhythm converted to NSR.jpg

Copyleft images obtained courtesy of ECGpedia.[1]


References

  1. 1.0 1.1 1.2 ecgpedia.org



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