The ecg findings of a regular narrow complex tachycardia with retrograde p waves merging with the qrs complex are consistent with atrioventricular nodal. A relatively common frustrating and anxietyprovoking situation in medical practice is the confrontation of a physician with a wide qrs complex tachycardia wct ecg tracing. Differential diagnosis of wide complex tachycardias ems 12 lead. The ecg meets most of the criteria for left bundle branch block. Impact syndrome combining ketamine and propofol ketofol for emergency.
Understand how does narrow complex and wide complex qrs occur. This wide complex tachycardia has an initial rate of 129min. Ecg have a key role for the differential diagnosis and therapy of widecomplex tachycardias. It is difficult to discern if p waves are present, although the ecg machine does give us a pr interval. Current algorithms for the diagnosis of wide qrs complex. It reveals a wide qrs complex tachycardia that is mainly regular, with a qrs duration of 180 milliseconds. In the clinical setting, the distinction between narrow and wide complex tachycardia supraventricular vs. Diagnostic criteria of broad qrs complex tachycardia.
The literature says that if the qrs width is greater than 0. The differential diagnosis of a wide qrs complex tachycardia with left bundle branch block and av dissociation in a patient with ischemic cardiomyopathy and hispurkinje disease is mainly ventricular tachycardia. Oct 05, 2012 wide complex tachycardiadiagnostic approachalgorithms sen. On the diagnosis of wide qrs tachycardia springerlink. You may find one of our health articles more useful.
Wide qrs complex tachycardia can be originated by 3 main mechanisms 1 ventricular tachycardia vt. Management requires advanced knowledge of ecg and rhythm. The ecg in figure 1 shows a wide qrs complex tachycardia at 170 bpm. The clinical situation that is commonly encountered is when the clinician is faced with an electrocardiogram ecg that shows a wide qrs complex tachycardia wct, qrs duration. Cme article what is the cause of the regular wide qrs complex. Wide complex tachycardia ecg guru instructor resources. Clinical research arrhythmiaelectrophysiology application of a new algorithm in the differential diagnosis of wide qrs complex tachycardia andra. The major clinical problem that arises when dealing with someone exhibiting a wide complex tachycardia is that it is not always immediately clear if the rhythm represents.
Diagnosis and treatment wide qrs complex tachycardias may be. Confirm wide complex tachycardia versus svt with abberancy do not use calcium channel blocker for wide complex unless absolutely certain of svt evaluate for secondary causes e. For over three decades of research, clinical debates, symposiums, seminars have effectively failed to take away the uncertainties in decoding the wide qrs tachycardia. Precedes the qrs complex is 23mm high 23 small squares high on the ecg paper has a duration 0. The initial four qrs complexes have an atypical right bundle branch block morphology suggesting either ventricular tachycardia vt or a preexcited tachycardia. It is easiest to understand this nomenclature by considering these terms independently. This studys aim is to compare the ability of two ecg criteria to differentiate ventricular vt from supraventricular tachycardia svt. Wide qrs complex tachycardia may be defined as tachycardia having qrs duration of greater than 120 ms 0. Consider adenosine only if regular and monomorphic.
A tachycardia is defined as a heart rate greater than 100 beats per minute bpm. Acls tachycardia algorithm for managing stable tachycardia. Ventricular arrhythmias are almost allways wide qrs complex arrhythmias. Understanding this complex condition part 2 management. When confronted with a wide qrs complex tachycardia it can be difficult to differentiate between a supraventricular tachycardia with aberrancy or ventricular tachycardia. Wide qrs complex tachycardia of uncertain origin in patients with stable wide qrs tachycardia of uncertain origin, adenosine and lidocaine previously were recommended. Specificity of wide qrs complex tachycardia criteria and algorithms.
Most have a narrow qrs complex, although, occasionally, electrical conduction abnormalities may produce a wide qrs complex that may mimic ventricular tachycardia vt. On first look, you will see a wide complex tachycardia wtc with a rate around 240 per minute. Wide complex tachycardia wide complex tachycardia is a cardiac rhythm with more than 100 ventricular beats per minute and a qrs complex of 120 ms or greater. Jan 01, 2009 by definition, a wide complex tachycardia is a heart rhythm with a qrs duration a. As a result, these infants may develop neonatal bradycardia or hypoglycemia. Application of a new algorithm in the differential diagnosis. May 14, 2015 professional reference articles are designed for health professionals to use. The differential diagnosis of a regular, monomorphic wide qrs complex tachycardia wct mechanism represents a great diagnostic dilemma commonly encountered by the practicing physician, which has important implications for acute arrhythmia management, further workup, prognosis and chronic management as well.
The pharmacologic and nonpharmacologic antiarrhythmic approaches discussed may, therefore, include some accahaesc guildelines 1859. Several arrhythmias can manifest as wcts table 211. Accahaesc guidelines for the management of patients with. The study may be underpowered to detect differences between groups.
Iv access and 12lead ecg, consider adenosine only if qrs is regular and monomorphic, consider antiarrhythmic infusion, and consider expert consultation 6. Specificity of electrocardiographic criteria for the differential diagnosis of wide qrs complex tachycardia in patients with intraventricular conduction defect. Wide qrs complexes not typical ofright or left bundle branch block and tall peaked t waves more vertical on their upstrokes than their downstrokes suggest hyperkalemia. On first look, you will see a widecomplex tachycardia wtc with a rate around 240 per minute. Adenosine may elicit hidden atrial activity, and it is particularly safe as the pacemaker should respond if prolonged av block or a brief period of asystole occurs. With newer pacemakers, this condition is less common. Tachycardias are broadly categorized based upon the width of the qrs complex on the electrocardiogram ecg. Jul 18, 20 tachycardias are broadly categorized based upon the width of the qrs complex on the electrocardiogram ecg. Supraventricular tachycardia svt with an aberrant conduction attributable to a preexisting bundlebranch block or functional bundlebranch block induced by the fast heart rate. A new approach to the differential diagnosis of a regular tachycardia with a wide qrs complex. In addition, the p wave in v4 seems to merge with the beginning of the qrs in other chest leads fig.
The differential diagnosis of wct includes ventricular tachycardia and supraventricular tachycardia with aberrant conduction, or interventricular. Wideqrs complexes not typical ofright or left bundle branch block and tall peaked t waves more vertical on their upstrokes than their downstrokes suggest hyperkalemia. After comparing, suggestions for better diagnosis of wide qrscomplex tachycardia wct in. During wide complex tachycardia heart rate 100min, qrs 0. When doubt exists in an emergency situation, it is safest to assume that a wide complex tachycardia is vt.
The elucidation of the mechanism of wct is vital not only for acute arrhythmia management, but also for the further workup, prognosis and chronic management. The differentiation of wide qrs complex tachycardias presents a challenging diagnostic dilemma to many physicians despite multiple published algorithms and approaches. Electrocardiogram showing a regular wide qrs tachycardia with left branch block lbbb like in morphology at 200 beats per minute bpm. Aberrancy, ventricular tachycardia, supraventricular tachycardia, rightbundle branch. In the differential diagnosis of a tachycardia with a wide qrs complex greater than or equal to 0. Note the wide qrs complexes, and the irregularly irregular rhythm. Narrow qrs tachycardia is always supraventricular which means that its source is proximal to the bundle of his, while wide qrs tachycardia can be ventricular source is in. It is difficult to assess for the presence of p waves because of the rate and the baseline artifact. A narrow qrs complex diagnosis and treatment wide qrs complex tachycardias. The differentiation of wide qrs complex tachycardias.
It is usually a regular, wide complex tachycardia with a rate between 120 and 250 beats per minute. Wide qrs complex tachycardia with alternating qrs complexes. Electrocardiographic criteria for ventricular tachycardia in wide complex left bundle branch block morphology tachycardia. Aug 18, 2007 wide complex tachycardias wcts are also known as broad complex or wide qrs complex tachycardias.
Cme article what is the cause of the regular wide qrs. Approach to wide qrs complex tachycardias clinical gate. The patient was found to have a single, right posterolateral accessory pathway and dual av nodal pathways. A wide qrs complex tachycardia what is the mechanism. Several algorithms have been developed to aid in this differentiation below. Differential diagnosis of wide qrs complex tachycardias.
Knowing this locate the possible site of origin of cardiac conduction, and its propagation into the ventricle in the narrow complex tachycardia and in wide complex tachycardia narrow and wide complex. Pdf broad qrs complex tachycardia still presents a diagnostic challenge when confronted. Arguably, this is the highestrisk population of those with a wide qrs complex. Wide qrs complex tachycardia the ecg in prehospital. Differential diagnosis of wide qrs complex tachycardias the.
It is a much fancied and glamorous entity for the simple reason, it continues to be the cardiologist ever solved puzzle. Mar 01, 2001 wide qrs complex tachycardia is a common arrhythmia in clinical practice and often presents a diagnostic challenge. Wide qrs tachycardia has a unique place in clinical electrocardiography. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Of those with wide qrs complexes, a nonspecific intraventricular conduction delay was the most common in buxtons report and, based on prior data, all ventricular conduction delays are not the same. Differential diagnosis for wide qrscomplex tachycardia. They are written by uk doctors and based on research evidence, uk and european guidelines. When this criteria is met, and the the rhythm is regular no variability in the rr interval then itas a regular wide complex tachycardia. Broad qrs complex tachycardia still presents a diagnostic challenge. A wide complex tachycardia may represent either vt 80% or a supraventricular rhythm with aberrant conduction 20%. Diagnosis and treatment wide qrs complex tachycardias may be either from ventricular or from. Pdf diagnostic criteria of broad qrs complex tachycardia. Before giving any antiarrhythmic medication, attempts should be made to determine the origin of the tachycardia.
Wide qrs complex tachycardia wct is a rhythm with a rate of more than 100 beatsmin and a qrs duration of more than 120 milliseconds. During electrophysiology study, it suddenly gets narrow and. Management and treatment for a stable tachycardia with a wide qrs complex and either a regular or irregular rhythm should be done in the hospital setting with expert consultation available. Apr 24, 2018 wide complex tachycardia posted in cardiology on april 24, 2018 by editor several algorithms exist for the electrocardigraphic evaluation of regular, wide complex tachycardias with the objective of distinguishing ventricular tachycardia vt from a supraventricular tachycardia svt with aberrant conduction. Wide complex tachycardiadiagnostic approachalgorithms sen. The mechanism of the wide qrs complex tachycardia was orthodromic reentrant tachycardia with aberrant. After combining your answers to 2 and 3, what is your final diagnosis and management. Application of a new algorithm in the differential diagnosis of wide qrs complex tachycardia. It is a reentrant circuit that involves anterograde conduction via the accessory bundle of his and retrograde reduction via the av node. Supraventricular tachycardia, ventricular tachycardia, wide qrs complex tachycardia. If regular narrow complex, consider adenosine wide qrs. Diagnosis and treatment wide qrs complex tachycardias.
5 798 1475 1343 1120 416 193 1060 14 473 889 1604 1085 1628 1077 569 397 1403 1058 897 568 607 565 1440 426 442 360 483 693 637 1496