Wide complex tachycardia electrocardiogram

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

Electrocardiogram

EKG examples and diagnosis here:

• Extreme axis deviation favors VT. Especially -90 to -180 or “northwest” or “superior” axis (23% of SVT will have SAD).
• QRS duration >140 msec favors VT (21% of VT will have QRS <140 msec).
• AV dissociation is demonstrated in only 21% of VT.
• Morphologic criteria:

  • 4% of SVT and 6% of VT did not fulfill criteria in any lead.
  • 40% will have discordance between V1/V2 and V5/V6. One lead may suggest VT while another suggests SVT.

• An algorithmic approach was proposed by Brugada in 1991. It has a reported sensitivity of 99% and specificity of 97%.

An overview of ventricular tachycardias, follow the wide complex tachycardia flowchart

	Example	Regularity	Atrial frequency	Ventricular frequency	Origin (SVT/VT)	p-wave	Effect of adenosine
Wide complex (QRS > 0.12)
Ventricular Tachycardia		regular (mostly)	60-100 bpm	110-250 bpm	ventricle (VT)	AV-dissociation	no rate reduction (sometimes accelerates)
Ventricular Fibrillation		irregular	60-100 bpm	400-600 bpm	ventricle (VT)	AV-dissociation	none
Ventricular Flutter		regular	60-100 bpm	150-300 bpm	ventricle (VT)	AV-dissociation	none
Accelerated Idioventricular Rhythm		regular (mostly)	60-100 bpm	50-110 bpm	ventricle (VT)	AV-dissociation	no rate reduction (sometimes accelerates)
Torsade de Pointes		regular		150-300 bpm	ventricle (VT)	AV-dissociation	no rate reduction (sometimes accelerates)
Bundle-branch re-entrant tachycardia*		regular	60-100 bpm	150-300 bpm	ventricles (VT)	AV-dissociation	no rate reduction
* Bundle-branch re-entrant tachycardia is extremely rare