EKG

Wide Complex Tachycardia

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Wide Complex Tachycardia, Ventricular Tachycardia

  • 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]
  • Differential Diagnosis
  • Wide Complex Tachycardia
  1. Ventricular Tachycardia
    1. Safest to start treating as Ventricular Tachycardia (see Ventricular Tachycardia Management for precautions)
    2. Criteria
      1. Tachycardia (Heart Rate >130, and typically >150 bpm) AND
      2. Wide QRS Complex (duration at least 0.12 sec)
      3. No P Wave to QRS Complex relationship (other than retrograde P Waves)
  2. Supraventricular Tachycardia with Aberrant Conduction
  3. Sinus Tachycardia with Aberrant Conduction
  • 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]
  • 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
  • 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]