Wide Complex Tachycardia

Aka: Wide Complex Tachycardia, Ventricular Tachycardia

II. Epidemiology

  1. Wide Complex Tachycardia in Children
    1. Presumptive Ventricular Tachycardia
  2. Wide Complex Tachycardia in Adults
    1. 75% of patients have Ventricular Tachycardia
    2. 90% of patients with CAD have VT
  3. References
    1. Akhtar (1988) Ann Intern Med 109:905-912 [PubMed]

III. Evaluation: Brugada criteria for Wide Complex Tachycardia

  1. Only treat as SVT with aberrancy if ALL 4 criteria are absent
    1. Rule has a Test Sensitivity and Test Specificity >96% for VT
  2. Criteria (presence of any one of which suggests Ventricular Tachycardia)
    1. RS complex absent from all precordial leads
    2. R to S interval >100 ms in one precordial lead
    3. Atrioventricular Dissociation
    4. Morphologic criteria for Ventricular Tachycardia in leads V1, V2, V6
  3. References
    1. Brugada (1991) Circulation 83(5): 1649-59 [PubMed]

IV. Management: Acute Wide Complex Tachycardia

  1. New emphasis on use of choosing only one Antiarrhythmic
    1. Contrast to prior Antiarrhythmic soups
    2. Pro-arrhythmic effects increase with poly-drugs
  2. See Ventricular Tachycardia Management in the Adult
  3. See Ventricular Tachycardia Management in the Child

V. Management: Chronic recurrent Ventricular Tachycardia

  1. Implantable Defibrillator (ICD)
    1. Long term best option (much better than meds)
    2. Efficacy: 40-50% reduction in sudden death
    3. References
      1. (1997) N Engl J Med 337:1576 [PubMed]
      2. Moss (1996) N Engl J Med 335:1933-40 [PubMed]
  2. Maximize Coronary Artery Disease management
    1. Bigger (1997) N Engl J Med 337:1569-75 [PubMed]

VI. Management: Ventricular Tachycardia Storm

  1. Incidence: 10-20% of those with AICD
  2. Definition
    1. More than 3 sustained VF or VT or appropriate ICD shocks in 3 hours
    2. Sustained VT lasts >30 sec or hemodynamic compromise
  3. Evaluation
    1. Confirm Wide Complex Tachycardia (versus SVT with abberancy)
      1. Do not use Calcium Channel Blocker for wide complex unless absolutely certain of SVT
    2. Evaluate for secondary causes (e.g. infection, Electrolytes, Creatinine, Hemoglobin, Troponin, drug levels)
    3. Confirm multiple appropriate shocks from AICD
      1. Deactivate device with magnet if inappropriate shocks
  4. Management
    1. Monomorphic VT (old MI scar)
      1. Amiodarone
      2. Beta Blockers
      3. Radiofrequency ablation (if preserved EF, at least >25%)
    2. Polymorphic VT with normal QT (MI within prior 72 hours)
      1. Coronary revascularization
    3. Polymorphic VT with Prolonged QT (Torsades de Pointes)
      1. Isoproterenol
      2. Over-drive pacing
      3. Magnesium
      4. Replace Potassium
    4. Ventricular Fibrillation: PVC-Initiated
      1. Radiofrequency ablation
    5. Ventricular Fibrillation: Brugada Syndrome
      1. Isoproterenol
      2. Quinidine (must be started before discontinuing Isoproterenol)
  5. References
    1. Roukoz (2018) Cardiac Arrhythmia Conference, UMN, Minneapolis

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Related Studies

Ontology: Tachycardia, Ventricular (C0042514)

Definition (NCI) A disorder characterized by an electrocardiographic finding of three or more consecutive complexes of ventricular origin with a rate greater than a certain threshold (100 or 120 beats per minute are commonly used). The QRS complexes are wide and have an abnormal morphology. (CDISC)
Definition (NCI_CTCAE) A disorder characterized by a dysrhythmia with a heart rate greater than 100 beats per minute that originates distal to the bundle of His.
Definition (NCI_FDA) An abnormally rapid ventricular rhythm with aberrant ventricular excitation, usually in excess of 150 beats per minute.
Definition (MSH) An abnormally rapid ventricular rhythm usually in excess of 150 beats per minute. It is generated within the ventricle below the BUNDLE OF HIS, either as autonomic impulse formation or reentrant impulse conduction. Depending on the etiology, onset of ventricular tachycardia can be paroxysmal (sudden) or nonparoxysmal, its wide QRS complexes can be uniform or polymorphic, and the ventricular beating may be independent of the atrial beating (AV dissociation).
Concepts Pathologic Function (T046)
MSH D017180
ICD10 I47.2
SnomedCT 195075005, 6624005, 155370003, 25569003
English Tachycardia, Ventricular, TACHYCARDIA VENTRICULAR, Tachycardias, Ventricular, Ventricular Tachycardias, Ventricular Tachycardia, ventricular tachycardia (diagnosis), ventricular tachycardia, V.tach, Tachycardia ventricular, Tachycardia, ventricular, Tachycardia, Ventricular [Disease/Finding], v tach, vt, ventricular tachyarrhythmia, ventricular tachycardia (V-tach), Ventricular tachycardia (Vtach), Tachycardia - ventric., Ventricular tachyarrhythmia (disorder), Ventricular techycardia, VENTRICULAR TACHYCARDIA, Ventricular tachycardia, VT - Ventricular tachycardia, Ventricular tachycardia (disorder), Ventricular tachyarrhythmia, tachycardia; ventricular, ventricular; tachycardia, Ventricular tachycardia, NOS, Tachycardia;ventricular
French TACHYCARDIE VENTRICULAIRE, Tachyarythmie ventriculaire, V.tach, Tachycardie ventriculaire
Portuguese TAQUICARDIA VENTRICULAR, Taquiarritmia ventricular, Taquicardia ventricular, Taquicardia Ventricular
Spanish TAQUICARDIA VENTRICULAR, Taquiarritmia ventricular, Taquicardia V, taquiarritmia ventricular, taquiarritmia ventricular (trastorno), taquicardia ventricular (trastorno), taquicardia ventricular, Taquicardia ventricular, Taquicardia Ventricular
Dutch ventriculaire tachyaritmie, ventrikeltachycardie, tachycardie; ventriculair, ventriculair; tachycardie, ventriculaire tachycardie, Ritmestoornis, Tachycardie, ventriculaire, Ventriculaire tachycardie
German Kammer-Tachyarrhythmie, V.tach, TACHYKARDIE VENTRIKULAER, Ventrikulaere Tachykardie, Tachykardie ventrikulaer, Tachykardie, ventrikuläre
Italian Tachiaritmia ventricolare, Tachicardia ventricolare
Japanese 心室性頻脈性不整脈, ｼﾝｼﾂｾｲﾋﾝﾐｬｸ, ｼﾝｼﾂｾｲﾋﾝﾐｬｸｾｲﾌｾｲﾐｬｸ, 心室性頻拍, 頻拍-心室性, 心室性頻拍症, 心室性頻脈, 心室頻拍, 心室頻拍症, 心室頻脈, 発作性心室性頻拍, 発作性心室性頻拍症, 発作性心室頻拍, 発作性心室頻拍症
Swedish Kammartakykardi
Finnish Kammiotakykardia
Russian TAKHIKARDIIA VENTRIKULIARNAIA, TAKHIKARDIIA ZHELUDOCHKOVAIA PAROKSIZMAL'NAIA, ТАХИКАРДИЯ ВЕНТРИКУЛЯРНАЯ, ТАХИКАРДИЯ ЖЕЛУДОЧКОВАЯ ПАРОКСИЗМАЛЬНАЯ
Czech Ventrikulární tachyarytmie, Tachykardie komorová, Komorová tachykardie, KT, VT, komorová tachykardie, tachykardie komorová
Korean 심실성 빠른맥
Croatian TAHIKARDIJA, VENTRIKULARNA
Polish VT, Tachykardia komorowa, Częstoskurcz komorowy
Hungarian Ventricularis tachyarrhythmia, Tachycardia,ventricularis, V . Tach., Ventricularis tachycardia
Norwegian Ventrikkeltakykardi, Takykardi, ventrikkel-, Ventrikulær takykardi
Derived from the NIH UMLS (Unified Medical Language System)

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