Broad complex tachycardia pdf

With newer pacemakers, this condition is less common. But as will be discussed here, the ecg should not only tell you how to distinguish vt from other tachycardias with a broad qrs complex, but also to suspect its. Fusion beats are slightly wider complexes followed by. Diagnosis and management of narrow and wide complex. The ecg shows a broad complex tachycardia, atrioventricular av dissociation, fusion beats, and capture beats. Routine blood tests, including full blood count and inflammatory markers, were unremarkable. P waves are seen throughout the tracings, but have no consistent relation to the qrs complexes and are occasionally followed by fusion beats. Management and diagnosis of narrow complex tachycardia. Role of echocardiography in differential diagnosis broad. Ventricular tachycardia as default diagnosis in broad. Symptoms may include palpitations, feeling faint, sweating, shortness of breath, or chest pain.

Broad complex tachycardia in a 46yearold man heart. Diagnostic criteria of broad qrs complex tachycardia. A wide qrs complex on tachycardia on electrocardiogram is defined as rhythm with qrs duration. Broad qrs complex tachycardias in the emergency department. 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. A history that includes ischaemic heart disease or congestive cardiac failure is 90% predictive of ventricular tachycardia. Current algorithms for the diagnosis of wide qrs complex ncbi. V relationship and avrt involving a retrograde concealed accessory pathway, wide qrs complex tachycardia is the result of delayed or blocked conduction. The differential diagnosis in wct includes ventricular tachycardia vt, supraventricular tachycardia svt with aberrancy and pacemaker rhythms. Medication given for the treatment of a supraventricular tachycardia svt may be harmful to a patient with a ventricular tachycardia vt. As a test for supraventricular origin of a regular broad complex tachycardia, it had 89% sensitivity, 94% specificity, and a 92% predictive accuracy.

Pdf broad qrs complex tachycardia still presents a diagnostic challenge when confronted with a 12lead electrocardiogram ecg. A 46yearold south asian male with no comorbidity presented with palpitations and presyncope. Wide complex tachycardia wct tachyarrhythmias with wide broad qrs complexes, defined as qrs duration. The ecg differential diagnosis includes ventricular tachycardia vt vs. The ecg on admission showed a broad complex tachycardia fig. Pdf diagnostic criteria of broad qrs complex tachycardia. The differentiation of broad qrs complex tachycar dias is a commonly encountered diagnostic dilemma in the emergency department. Regular broad complex tachycardia acute medicine wiley online. Subsequently the arrhythmia was ended after cardioversion with 10. In a stable patient, if the broadcomplex tachycardia is thought to be vt, treat with amiodarone 300 mg iv over 2060 min, followed by an infusion of 900 mg over 24 h. Broad complex tachycardia bct is defined as a heart rate 100 bpm with a qrs complex 0. Supraventricular tachycardia with aberrant conduction. Any supraventricular tachycardia can present as a wide qrs complex tachycardia.

As shown in fig 1, broad qrs tachycardia can be divided in three groups svt with bundle branch blockbundle branch block bbb may be preexisting or can occur when the refractory period of one of the bundle branches is reached because of the heart rate of the svt so called tachycardia related or phase 3 block. Algorithms predominantly use rate and regularity for detection, with electrograms egms helping in discrimination between ventricular vt and supraventricular tachycardias svt. In ventricular tachycardia the rate is normally 120300 beatsminute. Wide complex tachycardia ventricular tachycardia or not. When atrial fibrillation occurs with aberrant conduction and a rapid ventricular response, a totally irregular broad complex tachycardia is produced.

This article continues the discussion, started last week, on ventricular tachycardias and also examines how to determine whether a broad complex tachycardia is ventricular or supraventricular in origin. A widecomplex tachycardia suggests that conduction through the ventricle occurs through the slower myocytetomyocyte connections because of either av conduction via an accessory pathway or a ventricular origin and can be seen even with sinus rhythm. In avnrt, atrial tachyarrhythmias, atrial flutter with a fixed a. A wide complex tachycardia wct is simple enough to define.

Initial evaluation and management of widecomplex tachycardia. The lancet articles ventricular tachycardia as default diagnosis in broad complex tachycardia m. However, atrial tachyarrhythmias that conduct aberrantly may present as a widecomplex. Patients presently with broad qrs complex tachycardias are usually uncomfortable or have some form of hemodynamic distress requiring urgent attention. Broad complex tachycardias occur by various mechanisms and may be ventricular or supraventricular in origin. Assessment of tachycardia differential diagnosis of. When confronted with a tachycardia having a broad qrs complex, it is important to be able to differentiate between a supraventricular and a ventricular tachycardia.

Age is a useful factor in determining the origin of a broad complex tachycardia. A wide complex tachycardia is defined as a cardiac rhythm with a. Garratt md d a cardiac department, queen elizabeth hospital, birmingham b15 2th, uk b freeman hospital, newcastle upon tyne, uk c st georges hospital, london, uk d groby road hospital. However, an arrhythmia arising from the atria or the atrioventricular junction will produce a broad complex if associated with ventricular preexcitation or bundle branch block. Heart rates above the resting rate may be normal such as with exercise or abnormal such as. Capture beats are recognised by narrow qrs complexes followed by upright t waves. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Overall, this is a consensus document that includes evidence and expert opinions from several countries. Presentation a ventricular origin for a broad complex tachycardia is suggested if the patient is aged over 35 years and has a history of ischaemic heart disease or. Mcguire, mbbs, phd from the prince of wales hospital and eastern heart clinic, randwick, australia, and university of. Supraventricular tachycardia svt is an abnormally fast heart rhythm arising from improper electrical activity in the upper part of the heart. The differential diagnosis of wide qrs complex tachycardia. The electrocardiographic differential diagnosis includes ventricular tachycardia, supraventricular.

There was no history of chest pain, and no family history of premature atherosclerosis, cardiomyopathy or sudden death. If the tachycardia has a wide complex qrs and is stable, consult with an expert. Classification of tachycardias with a broad qrs complex. Adenosine was administered intravenously without any effect. Broad qrs complex tachycardia bct still presents a diagnostic challenge when confronted with a 12lead electrocardiogram ecg. Permanent pacemakers have the capacity to sense, detect, and store tachyarrhythmia episodes, providing clinicians with a valuable diagnostic tool that can be utilized for decision making and patient management. Summary this chapter focuses on management, causes, and differential diagnosis of patients with regular broad complex tachycardia. Accahaesc guidelines for the management of patients with. Broad complex tachycardiapart i pubmed central pmc. In the emergency setting most broad complex tachycardias have a ventricular origin. Roleofecjcwdiographyin different diagnosis ofbroadcaplextacjycrdiaf. Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. The bundle branch block may predate the tachycardia, or it may be a rate related functional block, occurring when atrial impulses arrive too rapidly for a bundle branch to conduct normally. Broad complex tachycardiapart ii pubmed central pmc.