Approach to the diagnosis of wide QRS complex tachycardias
- Leonard I Ganz, MD, FHRS, FACC
Leonard I Ganz, MD, FHRS, FACC
- Section Editor — Cardiac Arrhythmias
- Director of Cardiac Electrophysiology
- Heritage Valley Health System
- Section Editors
- Peter J Zimetbaum, MD
Peter J Zimetbaum, MD
- Section Editor — Cardiac Arrhythmias
- Associate Professor of Medicine
- Harvard Medical School
- Ary L Goldberger, MD
Ary L Goldberger, MD
- Section Editor — Electrocardiography
- Professor of Medicine
- Harvard Medical School
- James Hoekstra, MD
James Hoekstra, MD
- Section Editor — Adult Cardiology Emergencies
- Professor and Fredrick Glass Chair
- Wake Forest University
Tachycardias are broadly categorized based upon the width of the QRS complex on the electrocardiogram (ECG).
●A narrow QRS complex (<120 msec) reflects rapid activation of the ventricles via the normal His-Purkinje system, which in turn suggests that the arrhythmia originates above or within the atrioventricular (AV) node (ie, a supraventricular tachycardia [SVT]).
●A widened QRS (≥120 msec) occurs when ventricular activation is abnormally slow for one of the following reasons (see 'Causes of WCT' below):
•The arrhythmia originates outside of the normal conduction system (ie, ventricular tachycardia [VT])
•Abnormalities within the His-Purkinje system (ie, SVT with aberrancy)
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- INITIAL APPROACH
- Assessment of stability
- Physical examination
- Ancillary testing
- Early diagnostic/therapeutic interventions
- CLINICAL MANIFESTATIONS
- CAUSES OF WCT
- Ventricular tachycardia
- Artifact mimicking VT
- Supraventricular tachycardia
- - Aberrant conduction
- - Preexcitation syndrome
- - Pacemakers
- EVALUATION OF THE ELECTROCARDIOGRAM
- Basic features
- AV dissociation
- - Dissociated P waves
- - Fusion and capture beats
- QRS morphology
- - Diagnostic criteria
- - Variation in QRS and ST-T shape
- Our approach
- Brugada criteria
- Alternative approaches
- VT versus AVRT
- Algorithm performance
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS