Wide complex tachycardia causes

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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

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 (AVRT) account for 1% to 6% of WCTs.[3]

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).

Causes

Common Causes

Across All Ages

Among Patients Under 35 Years of Age

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

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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