Wide complex tachycardia causes

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

Overview

A wide complex tachycardia is either of ventricular origin (ventricular tachycardia or VT), or is of supraventricular origin with aberrant conduction (SVT with aberrancy) such as occurs with conduction down a bypass tract. Approximately 80% of wide complex tachycardias are due to ventricular tachycardia. Therefore a thorough review of the potential causes of ventricular tachycardia is critical in the patient with a wide complex tachycardia.

Ventricular Tachycardia

Common causes of ventricular tachycardia include ischemic heart disease, illicit drugs (cocaine and methamphetamine), structural heart disease (including congenital heart diseases such as tetralogy of Fallot), inherited channelopathies, drug toxicity (digoxin, drugs that prolong the QT interval) and electrolyte disturbances (such as hypokalemia, hypomagnesemia, and hypocalcemia).

Common Causes

Across All Ages

• Congestive heart failure
• Hypokalemia
• Hypomagnesemia
• STEMI

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

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, Caffeine,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

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

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:

• Atrial flutter with 2:1 conduction and occasional 1:1 conduction
• Automatic junctional tachycardia
• AV nodal reentrant tachycardia
• AV reentrant tachycardia using a bypass tract
• Intraatrial reentrant tachycardia
• Paroxysmal atrial tachycardia
• SA nodal reentrant tachycardia
• Sinus tachycardia

• Antegrade conduction down an accessory bypass tract for instance in Wolff Parkinson White syndrome (WPW)