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| [[Wide complex tachycardia resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{Wide complex tachycardia}}
{{Wide complex tachycardia}}
{{CMG}}
{{CMG}}
==Overview==
A wide complex tachycardia (WCT) is either of ventricular origin ([[ventricular tachycardia]]), of supraventricular origin with aberrant conduction ([[SVT]] with aberrancy), of supraventricular origin and is conducted down a [[bypass tract]] such as in [[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White syndrome (WPW)]], or is due to a pacemaker malfunction.  The most common cause of WCT is [[ventricular tachycardia|ventricular tachycardia (VT)]], which accounts for 80% of all cases of WCT.<ref name="pmid16951728">{{cite journal |author=Lam P, Saba S |title=Approach to the evaluation and management of wide complex tachycardias |journal=[[Indian Pacing and Electrophysiology Journal]] |volume=2 |issue=4 |pages=120–6 |year=2002 |pmid=16951728 |pmc=1557420 |doi= |url=http://www.ipej.org/2/120 |issn= |accessdate=2013-08-04}}</ref><ref name="pmid11233948">{{cite journal| author=Gupta AK, Thakur RK| title=Wide QRS complex tachycardias. | journal=Med Clin North Am | year= 2001 | volume= 85 | issue= 2 | pages= 245-66, ix-x | pmid=11233948 | doi= | pmc= | url= }} </ref>  [[Supraventricular tachycardia|Supraventricular tachycardia (SVT)]] with aberrancy accounts for 15% to 20% of WCTs.  SVTs with [[preexcitation]] and [[AV reentrant tachycardia#Retrograde Reentrant Tachycardia|antidromic atrioventricular reentrant tachycardia]] account for 1% to 6% of WCTs.<ref name='book1'>Issa Z, Miller JM, Zipes DP(2009). Approach to Wide QRS Complex Tachycardias. '' Arrhythmology and Electrophysiology:
A Companion to Braunwald's heart disease'' (1st ed., pp. 393). Philadelphia, Pa: Saunders Elsevier.</ref>


==Causes==
==Causes==
A wide complex tachycardia (WCT) can be due to either:
===Ventricular Tachycardia Causes===
===Ventricular Tachycardia===
====Life Threatening Causes====
* [[Ventricular tachycardia]] ([[VT]])  (80% of cases, 98% of cases if [[coronary heart disease]] or structural heart disease are present)
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
 
*[[STEMI]]
*[[Unstable angina]]
 
====Common Causes====
*[[AV reentrant tachycardia]]
*[[Pre-excitation syndrome]]
*[[Supraventricular tachycardia]]
*[[Ventricular tachycardia]]
 
====Causes by Organ System====
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute coronary syndrome]], [[Andersen cardiodysrhythmic periodic paralysis]], [[arrhythmogenic right ventricular dysplasia]], [[AV block]], [[cardiomyopathy]], [[catecholaminergic polymorphic ventricular tachycardia]], [[congenital heart disease]], [[congestive heart failure]], [[hypertrophic cardiomyopathy]], [[ischaemic heart disease]], [[Jervell and Lange-Nielsen syndrome]], [[long QT Syndrome]], [[myocardial Infarction]], [[myocarditis]], [[NSTEMI]], [[right ventricular outflow tract tachycardia]], [[Romano-Ward syndrome]], [[short QT syndrome]], [[short QT syndrome type 1]], [[short QT syndrome type 2]], [[short QT syndrome type 3]], [[short QT syndrome type 4]], [[short QT syndrome type 5]], [[STEMI]], [[Timothy syndrome]], [[torsade de pointes]], [[unstable angina]], [[valvular heart disease]], [[ventricular aneurysm]], [[Wolff-Parkinson-White syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Arsenic trioxide]], [[arsenicals]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Alimemazine]], [[almokalant]], [[amiodarone]], [[amitriptyline]], [[amphetamines]], [[antiarrhythmics]], [[asenapine]], [[astemizole]], [[azimilide]], [[azithromycin]], [[bepridil]], [[bretylium]], [[budipine]], [[chloroquine]], [[cibenzoline]], [[cisapride]], [[citalopram]], [[clomipramine]], [[clozapine]], [[cocaine]], [[crizotinib]], [[desipramine]], [[digitalis]], [[diphenhydramine]], [[disopyramide]], [[dofetilide]], [[dolasetron]], [[doxepin]], [[dronedarone]], [[droperidol]], [[eribulin mesylate]], [[fluconazole]], [[grepafloxacin]], [[halofantrine]], [[haloperidol]], [[ibutilide]], [[imipramine]], [[indapamide]], [[inotropes]], [[ketanserin]], [[ketoconazole]], [[lidoflazine]], [[lubeluzole]], [[methadone]], [[methadyl acetate]], [[methamphetamine]], [[midodrine]], [[mizolastine]], [[moxifloxacin]], [[naratriptan]], [[nicardipine]], [[nilotinib]], [[ondansetron]], [[pasireotide]], [[pazopanib]], [[pentamidine]], [[phenothiazines]], [[pimozide]], [[piperaquine]], [[prenylamine]], [[probucol]], [[procainamide]], [[propoxyphene]], [[quinidine]], [[quinine]], [[ranolazine]], [[retigabine]], [[ritodrine]], [[ritonavir]], [[saquinavir]], [[sertindole]], [[sotalol]], [[sparfloxacin]], [[sympathomimetic agents]], [[tedisamil]], [[telithromycin]], [[terfenadine]], [[terodiline]], [[tetrabenazine]], [[thioridazine]], [[vandetanib]], [[vemurafenib]], [[venlafaxine]], [[vernakalant]], [[voriconazole]], [[vorinostat]], [[ziprasidone]], [[zotepine]], [[zuclopenthixol]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Hyperthyroidism]], [[hypothyroidism]], [[pheochromocytoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[Hypothermia]], [[zero gravity]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Channelopathies]], [[myotonic dystrophy]], [[Andersen cardiodysrhythmic periodic paralysis]], [[Jervell and Lange-Nielsen syndrome]], [[Romano-Ward syndrome]], [[short QT syndrome type 1]], [[short QT syndrome type 2]], [[short QT syndrome type 3]], [[short QT syndrome type 4]], [[short QT syndrome type 5]], [[Timothy syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Cardioversion]], [[defibrillation]], [[electrophysiologic studies]], [[heart surgery]], [[pulmonary artery catheter ]], [[right heart catheterisation]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Andersen cardiodysrhythmic periodic paralysis]], [[Timothy syndrome]], [[myotonic dystrophy]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Acidosis]], [[acid-base disturbances]], [[acute starvation]], [[electrolyte imbalance]], [[hyperkalaemia]], [[hypocalcemia]], [[hypoglycaemia]], [[hypokalemia]], [[hypomagnesemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Alimemazine]], [[almokalant]], [[amiodarone]], [[amitriptyline]], [[amphetamines]], [[antiarrhythmics]], [[asenapine]], [[astemizole]], [[azimilide]], [[azithromycin]], [[bepridil]], [[bretylium]], [[budipine]], [[chloroquine]], [[cibenzoline]], [[cisapride]], [[citalopram]], [[clomipramine]], [[clozapine]], [[cocaine]], [[crizotinib]], [[desipramine]], [[digitalis]], [[diphenhydramine]], [[disopyramide]], [[dofetilide]], [[dolasetron]], [[doxepin]], [[dronedarone]], [[droperidol]], [[eribulin mesylate]], [[fluconazole]], [[grepafloxacin]], [[halofantrine]], [[haloperidol]], [[ibutilide]], [[imipramine]], [[indapamide]], [[inotropes]], [[ketanserin]], [[ketoconazole]], [[lidoflazine]], [[lubeluzole]], [[methadone]], [[methadyl acetate]], [[methamphetamine]], [[midodrine]], [[mizolastine]], [[moxifloxacin]], [[naratriptan]], [[nicardipine]], [[nilotinib]], [[ondansetron]], [[pasireotide]], [[pazopanib]], [[pentamidine]], [[phenothiazines]], [[pimozide]], [[piperaquine]], [[prenylamine]], [[probucol]], [[procainamide]], [[propoxyphene]], [[quinidine]], [[quinine]], [[ranolazine]], [[retigabine]], [[ritodrine]], [[ritonavir]], [[saquinavir]], [[sertindole]], [[sotalol]], [[sparfloxacin]], [[sympathomimetic agents]], [[tedisamil]], [[telithromycin]], [[terfenadine]], [[terodiline]], [[tetrabenazine]], [[thioridazine]], [[vandetanib]], [[vemurafenib]], [[venlafaxine]], [[vernakalant]], [[voriconazole]], [[vorinostat]], [[ziprasidone]], [[zotepine]], [[zuclopenthixol]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Anorexia nervosa]], [[starvation]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Hypoxia]], [[obstructive sleep apnea]], [[sleep apnea]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Acidosis]], [[acid-base disturbances]], [[acute starvation]], [[electrolyte imbalance]], [[hyperkalaemia]], [[hypocalcemia]], [[hypoglycaemia]], [[hypokalemia]], [[hypomagnesemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Myocardial contusion]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|  No underlying causes
|-
|}
 
====Causes in Alphabetical Order====
{{columns-list|
*[[Acid-base disturbances]]
*[[Acidosis]]
*[[Acute coronary syndrome]]
*[[Acute starvation]]
*[[Alimemazine]]
*[[Almokalant]]
*[[Amiodarone]]
*[[Amitriptyline]]
*[[Amphetamines]]
*[[Andersen cardiodysrhythmic periodic paralysis]]
*[[Anorexia nervosa]]
*[[Antiarrhythmics]]
*[[Arrhythmogenic right ventricular dysplasia]]
*[[Arsenic trioxide]]
*[[Arsenicals]]
*[[Asenapine]]
*[[Astemizole]]
*[[AV block]]
*[[Azimilide]]
*[[Azithromycin]]
*[[Bepridil]]
*[[Bretylium]]
*[[Budipine]]
*[[Caffeine]]
*[[Cardiomyopathy]]
*[[Cardioversion]]
*[[Catecholaminergic polymorphic ventricular tachycardia]]
*[[Channelopathies]]
*[[Chloroquine]]
*[[Cibenzoline]]
*[[Cisapride]]
*[[Citalopram]]
*[[Clomipramine]]
*[[Clozapine]]
*[[Cocaine]]
*[[Congenital heart disease]]
*[[Congestive heart failure]]
*[[Crizotinib]]
*[[Defibrillation]]
*[[Desipramine]]
*[[Digitalis]]
*[[Diphenhydramine]]
*[[Disopyramide]]
*[[Dofetilide]]
*[[Dolasetron]]
*[[Doxepin]]
*[[Dronedarone]]
*[[Droperidol]]
*[[Electrolyte imbalance]]
*[[Electrophysiologic studies]]
*[[Eribulin mesylate]]
*[[Fluconazole]]
*[[Grepafloxacin]]
*[[Halofantrine]]
*[[Haloperidol]]
*[[Heart surgery]]
*[[Hyperkalaemia]]
*[[Hyperthyroidism]]
*[[Hypertrophic cardiomyopathy]]
*[[Hypocalcemia]]
*[[Hypoglycaemia]]
*[[Hypokalemia]]
*[[Hypomagnesemia]]
*[[Hypothermia]]
*[[Hypothyroidism]]
*[[Hypoxia]]
*[[Ibutilide]]
*[[Imipramine]]
*[[Indapamide]]
*[[Inotropes]]
*[[Ischaemic heart disease]]
*[[Jervell and Lange-Nielsen syndrome]]
*[[Ketanserin]]
*[[Ketoconazole]]
*[[Lidoflazine]]
*[[Long QT Syndrome]]
*[[Lubeluzole]]
*[[Methadone]]
*[[Methadyl acetate]]
*[[Methamphetamine]]
*[[Midodrine]]
*[[Mizolastine]]
*[[Moxifloxacin]]
*[[Myocardial infarction]]
*[[Myocarditis]]
*[[Myotonic dystrophy]]
*[[Naratriptan]]
*[[Nicardipine]]
*[[Nilotinib]]
*[[NSTEMI]]
*[[Obstructive sleep apnea]]
*[[Ondansetron]]
*[[Pasireotide]]
*[[Pazopanib]]
*[[Pentamidine]]
*[[Phenothiazines]]
*[[Pheochromocytoma]]
*[[Pimozide]]
*[[Piperaquine]]
*[[Prenylamine]]
*[[Probucol]]
*[[Procainamide]]
*[[Propoxyphene]]
*[[Pulmonary artery catheter]]
*[[Quinidine]]
*[[Quinine]]
*[[Ranolazine]]
*[[Retigabine]]
*[[Right heart catheterisation]]
*[[Right ventricular outflow tract tachycardia]]
*[[Ritodrine]]
*[[Ritonavir]]
*[[Romano-Ward syndrome]]
*[[Saquinavir]]
*[[Sertindole]]
*[[Short QT syndrome]]
*[[Short QT syndrome type 1]]
*[[Short QT syndrome type 2]]
*[[Short QT syndrome type 3]]
*[[Short QT syndrome type 4]]
*[[Short QT syndrome type 5]]
*[[Sleep apnea]]
*[[Sotalol]]
*[[Sparfloxacin]]
*[[STEMI]]
*[[Sympathomimetic agents]]
*[[Tedisamil]]
*[[Telithromycin]]
*[[Terfenadine]]
*[[Terodiline]]
*[[Tetrabenazine]]
*[[Thioridazine]]
*[[Timothy syndrome]]
*[[Torsade de pointes]]
*[[Unstable angina]]
*[[Valvular heart disease]]
*[[Vandetanib]]
*[[Vemurafenib]]
*[[Venlafaxine]]
*[[Ventricular aneurysm]]
*[[Vernakalant]]
*[[Voriconazole]]
*[[Vorinostat]]
*[[Wolff-Parkinson-White syndrome]]
*[[Zero gravity]]
*[[Ziprasidone]]
*[[Zotepine]]
*[[Zuclopenthixol]]
}}
 
====Causes Across All Ages====
*[[Congestive heart failure]]
*[[Hypokalemia]]
*[[Hypomagnesemia]]
*[[STEMI]]
 
====Causes Among Patients Under 35 Years of Age====
*[[Arrhythmogenic right ventricular dysplasia]]
*[[Hypertrophic cardiomyopathy]]
*[[Long QT syndrome]]
*[[Myocarditis]]
*[[Short QT syndrome]]
* [[Short QT syndrome type 1]]
* [[Short QT syndrome type 2]]
* [[Short QT syndrome type 3]]
* [[Short QT syndrome type 4]]
* [[Short QT syndrome type 5]]
 
===Supraventricular Tachycardia===
===Supraventricular Tachycardia===
* [[Supraventricular tachycardia]] ([[SVT]]) with aberrant ventricular conduction, which is either new or due to a preexisting left or right [[bundle branch block]] or a preexisting nonspecific [[intraventricular conduction delay]] ([[IVCD]]).  The underlying supraventricular rhythm that is aberrantly conducted can be any one of the following rhythms:
* [[Supraventricular tachycardia]] ([[SVT]]) with aberrant ventricular conduction is either new or due to a preexisting left or right [[bundle branch block]] or a preexisting nonspecific [[intraventricular conduction delay]] ([[IVCD]]).  The underlying supraventricular rhythm that is aberrantly conducted can be any one of the following rhythms:
:* Antegrade conduction down an [[accessory bypass tract]]
:* [[Atrial flutter]] with 2:1 conduction and occasional 1:1 conduction
:* [[Atrial flutter]] with 2:1 conduction and occasional 1:1 conduction
:* Automatic [[junctional tachycardia]]
:* Automatic [[junctional tachycardia]]
:* [[AV nodal reentrant tachycardia]]
:* [[AV nodal reentrant tachycardia]]
:* [[AV reentrant tachycardia]] using a bypass tract
:* [[AV reentrant tachycardia]] using a [[bypass tract]]
:* Intraatrial reentrant tachycardia
:* [[Intraatrial reentrant tachycardia]]
:* [[Paroxysmal atrial tachycardia]]
:* [[Paroxysmal atrial tachycardia]]
:* SA nodal reentrant tachycardia
:* [[SA nodal reentrant tachycardia]]
:* [[Sinus tachycardia]]
:* [[Sinus tachycardia]]
==Pre-Excitation Syndrome==
The diagnosis of rapid antegrade conduction down a [[bypass tract]] due to ventricular pre-excitation such as [[Wolff-Parkinson-White syndrome]] ([[WPW]]) should be considered if
:*There is intermittent present of a [[delta wave]]
:*There is intermittently a short [[PR interval]]
==Paced Rhythms==
A paced rhythm as a cause of wide complex tachycardia is infrequent.  This diagnosis is suggested in the following scenarios:
:*A pacemaker is in place and there is a [[LBBB]] pattern with superior left axis deviation, however, depending on the site of pacing this pattern can vary significantly
:*A wide complex tachycardia is due to an SVT and the pacemaker is tracking sensed atrial activity and is pacing the ventricles rapidly as result
:*[[Pacemaker-mediated tachycardia]] in which there is retrograde conduction which triggers atrial activity during ventricular pacing
:*[[Runaway pacemaker syndrome]] in which the pacemaker fires at a rate of nearly 2000 bpm and captures intermittently
:*[[Sensor induced tachycardia]] in which case the pacemaker fires at a rate of nearly 160-180 bpm in response to electrocautery, noise, vibration, limb movement or other stimuli


==References==
==References==
{{Reflist|2}}


{{Reflist|2}}
{{WH}}
{{WS}}
[[Category:Electrophysiology]]
[[Category:Electrophysiology]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:Crowdiagnosis]]
{{WH}}
{{WS}}

Latest revision as of 19:28, 10 January 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A wide complex tachycardia (WCT) is either of ventricular origin (ventricular tachycardia), of supraventricular origin with aberrant conduction (SVT with aberrancy), of supraventricular origin and is conducted down a bypass tract such as in Wolff-Parkinson-White syndrome (WPW), or is due to a pacemaker malfunction. The most common cause of WCT is ventricular tachycardia (VT), which accounts for 80% of all cases of WCT.[1][2] Supraventricular tachycardia (SVT) with aberrancy accounts for 15% to 20% of WCTs. SVTs with preexcitation and antidromic atrioventricular reentrant tachycardia account for 1% to 6% of WCTs.[3]

Causes

Ventricular Tachycardia Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Acute coronary syndrome, Andersen cardiodysrhythmic periodic paralysis, arrhythmogenic right ventricular dysplasia, AV block, cardiomyopathy, catecholaminergic polymorphic ventricular tachycardia, congenital heart disease, congestive heart failure, hypertrophic cardiomyopathy, ischaemic heart disease, Jervell and Lange-Nielsen syndrome, long QT Syndrome, myocardial Infarction, myocarditis, NSTEMI, right ventricular outflow tract tachycardia, Romano-Ward syndrome, short QT syndrome, short QT syndrome type 1, short QT syndrome type 2, short QT syndrome type 3, short QT syndrome type 4, short QT syndrome type 5, STEMI, Timothy syndrome, torsade de pointes, unstable angina, valvular heart disease, ventricular aneurysm, Wolff-Parkinson-White syndrome
Chemical / poisoning Arsenic trioxide, arsenicals
Dermatologic No underlying causes
Drug Side Effect Alimemazine, almokalant, amiodarone, amitriptyline, amphetamines, antiarrhythmics, asenapine, astemizole, azimilide, azithromycin, bepridil, bretylium, budipine, chloroquine, cibenzoline, cisapride, citalopram, clomipramine, clozapine, cocaine, crizotinib, desipramine, digitalis, diphenhydramine, disopyramide, dofetilide, dolasetron, doxepin, dronedarone, droperidol, eribulin mesylate, fluconazole, grepafloxacin, halofantrine, haloperidol, ibutilide, imipramine, indapamide, inotropes, ketanserin, ketoconazole, lidoflazine, lubeluzole, methadone, methadyl acetate, methamphetamine, midodrine, mizolastine, moxifloxacin, naratriptan, nicardipine, nilotinib, ondansetron, pasireotide, pazopanib, pentamidine, phenothiazines, pimozide, piperaquine, prenylamine, probucol, procainamide, propoxyphene, quinidine, quinine, ranolazine, retigabine, ritodrine, ritonavir, saquinavir, sertindole, sotalol, sparfloxacin, sympathomimetic agents, tedisamil, telithromycin, terfenadine, terodiline, tetrabenazine, thioridazine, vandetanib, vemurafenib, venlafaxine, vernakalant, voriconazole, vorinostat, ziprasidone, zotepine, zuclopenthixol
Ear Nose Throat No underlying causes
Endocrine Hyperthyroidism, hypothyroidism, pheochromocytoma
Environmental Hypothermia, zero gravity
Gastroenterologic No underlying causes
Genetic Channelopathies, myotonic dystrophy, Andersen cardiodysrhythmic periodic paralysis, Jervell and Lange-Nielsen syndrome, Romano-Ward syndrome, short QT syndrome type 1, short QT syndrome type 2, short QT syndrome type 3, short QT syndrome type 4, short QT syndrome type 5, Timothy syndrome
Hematologic No underlying causes
Iatrogenic Cardioversion, defibrillation, electrophysiologic studies, heart surgery, pulmonary artery catheter , right heart catheterisation
Infectious Disease No underlying causes
Musculoskeletal / Ortho Andersen cardiodysrhythmic periodic paralysis, Timothy syndrome, myotonic dystrophy
Neurologic No underlying causes
Nutritional / Metabolic Acidosis, acid-base disturbances, acute starvation, electrolyte imbalance, hyperkalaemia, hypocalcemia, hypoglycaemia, hypokalemia, hypomagnesemia
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity Alimemazine, almokalant, amiodarone, amitriptyline, amphetamines, antiarrhythmics, asenapine, astemizole, azimilide, azithromycin, bepridil, bretylium, budipine, chloroquine, cibenzoline, cisapride, citalopram, clomipramine, clozapine, cocaine, crizotinib, desipramine, digitalis, diphenhydramine, disopyramide, dofetilide, dolasetron, doxepin, dronedarone, droperidol, eribulin mesylate, fluconazole, grepafloxacin, halofantrine, haloperidol, ibutilide, imipramine, indapamide, inotropes, ketanserin, ketoconazole, lidoflazine, lubeluzole, methadone, methadyl acetate, methamphetamine, midodrine, mizolastine, moxifloxacin, naratriptan, nicardipine, nilotinib, ondansetron, pasireotide, pazopanib, pentamidine, phenothiazines, pimozide, piperaquine, prenylamine, probucol, procainamide, propoxyphene, quinidine, quinine, ranolazine, retigabine, ritodrine, ritonavir, saquinavir, sertindole, sotalol, sparfloxacin, sympathomimetic agents, tedisamil, telithromycin, terfenadine, terodiline, tetrabenazine, thioridazine, vandetanib, vemurafenib, venlafaxine, vernakalant, voriconazole, vorinostat, ziprasidone, zotepine, zuclopenthixol
Psychiatric Anorexia nervosa, starvation
Pulmonary Hypoxia, obstructive sleep apnea, sleep apnea
Renal / Electrolyte Acidosis, acid-base disturbances, acute starvation, electrolyte imbalance, hyperkalaemia, hypocalcemia, hypoglycaemia, hypokalemia, hypomagnesemia
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma Myocardial contusion
Urologic No underlying causes
Dental No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Causes Across All Ages

Causes Among Patients Under 35 Years of Age

Supraventricular Tachycardia

Pre-Excitation Syndrome

The diagnosis of rapid antegrade conduction down a bypass tract due to ventricular pre-excitation such as Wolff-Parkinson-White syndrome (WPW) should be considered if

Paced Rhythms

A paced rhythm as a cause of wide complex tachycardia is infrequent. This diagnosis is suggested in the following scenarios:

  • A pacemaker is in place and there is a LBBB pattern with superior left axis deviation, however, depending on the site of pacing this pattern can vary significantly
  • A wide complex tachycardia is due to an SVT and the pacemaker is tracking sensed atrial activity and is pacing the ventricles rapidly as result
  • Pacemaker-mediated tachycardia in which there is retrograde conduction which triggers atrial activity during ventricular pacing
  • Runaway pacemaker syndrome in which the pacemaker fires at a rate of nearly 2000 bpm and captures intermittently
  • Sensor induced tachycardia in which case the pacemaker fires at a rate of nearly 160-180 bpm in response to electrocautery, noise, vibration, limb movement or other stimuli

References

  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.
  2. ↑ Gupta AK, Thakur RK (2001). "Wide QRS complex tachycardias". Med Clin North Am. 85 (2): 245–66, ix–x. PMID 11233948.
  3. ↑ Issa Z, Miller JM, Zipes DP(2009). Approach to Wide QRS Complex Tachycardias. Arrhythmology and Electrophysiology: A Companion to Braunwald's heart disease (1st ed., pp. 393). Philadelphia, Pa: Saunders Elsevier.

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