II. Epidemiology
- Wide Complex Tachycardia in Children
- Presumptive Ventricular Tachycardia
- Wide Complex Tachycardia in Adults
- 75% of patients have Ventricular Tachycardia
- 90% of patients with CAD have VT
- References
III. Differential Diagnosis: Wide Complex Tachycardia
- Ventricular Tachycardia
- Safest to start treating as Ventricular Tachycardia (see Ventricular Tachycardia Management for precautions)
- Criteria
- Tachycardia (Heart Rate >130, and typically >150 bpm) AND
- Wide QRS Complex (duration at least 0.12 sec)
- No P Wave to QRS Complex relationship (other than retrograde P Waves)
- Other findings suggestive of Ventricular Tachycardia
- Right bundle branch morphology of the QRS (RSR' or "rabbit ears")
- R Wave taller than the R' wave (Left rabbit ear taller than the right)
- Fusion Beats
- Supraventricular and ventricular waves fuse to form an irregular QRS
- Right bundle branch morphology of the QRS (RSR' or "rabbit ears")
- References
- Mattu (2022) Crit Dec Emerg Med 36(5): 11
-
Supraventricular Tachycardia with Aberrant Conduction
- Prior EKG demonstrating Left Bundle Branch Block
- QRS wide, regular and consistent across EKG leads
- Sinus Tachycardia with Aberrant Conduction
IV. Evaluation: Brugada criteria for Wide Complex Tachycardia
- Only treat as SVT with aberrancy if ALL 4 criteria are absent
- Rule has a Test Sensitivity and Test Specificity >96% for VT
- Criteria (presence of any one of which suggests Ventricular Tachycardia)
- RS complex absent from all precordial leads
- R to S interval >100 ms in one precordial lead
- Atrioventricular Dissociation
- Morphologic criteria for Ventricular Tachycardia in leads V1, V2, V6
- References
V. Management: Acute Wide Complex Tachycardia
- New emphasis on use of choosing only one Antiarrhythmic
- Contrast to prior Antiarrhythmic soups
- Pro-arrhythmic effects increase with poly-drugs
- See Ventricular Tachycardia Management in the Adult
- See Ventricular Tachycardia Management in the Child
VI. Management: Chronic recurrent Ventricular Tachycardia
-
Implantable Defibrillator (ICD)
- Long term best option (much better than meds)
- Efficacy: 40-50% reduction in sudden death
- References
- Maximize Coronary Artery Disease management