Management and evaluation of wide QRS complex tachycardia in children
- Susan P Etheridge, MD
Susan P Etheridge, MD
- Professor of Pediatrics
- University of Utah School of Medicine
- Section Editors
- John K Triedman, MD
John K Triedman, MD
- Section Editor — Pediatric Cardiology
- Professor of Pediatrics
- Harvard Medical School
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Director, Division of Pediatric Emergency Medicine
- Associate Professor of Emergency Medicine and Pediatrics (Clinical)
- NYU School of Medicine
Wide QRS tachycardia may be due to ventricular tachycardia (VT), supraventricular tachycardia (SVT) with aberrant conduction, or atrioventricular reentrant tachycardia (AVRT) with an accessory pathway. Children with wide QRS complex tachycardia may present with hemodynamic instability, and if not emergently treated, serious morbidity or death may occur. (See "Pediatric advanced life support (PALS)".)
The management and evaluation of wide QRS complex tachycardia in children will be presented here. The causes of wide QRS complex tachycardia in children are discussed separately. (See "Causes of wide QRS complex tachycardia in children".)
The following terms are used throughout this topic:
●Tachycardia – Tachycardia in children is generally defined as a heart rate above the normal range for age (ie, >160 beats per minute [BPM] for infants under age two, >140 BPM for children two to twelve years, and >100 BPM for adolescents and adults (table 1)).
●Wide QRS complex – Wide QRS complex is defined by a QRS duration >80 msec in younger children and >100 msec in adolescents.
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- INITIAL MANAGEMENT
- Cardiac arrest
- Unstable patient
- - Initial treatment
- - Shock-resistant tachyarrhythmia
- - Torsades de pointes
- - Further evaluation and management
- Stable patient
- - Goals
- - Evaluation
- Ongoing monitoring
- Physical examination
- Laboratory tests
- - Management
- Empiric intervention
- Specific therapy
- - Ventricular tachycardia
- - Supraventricular tachycardia
- CHRONIC MANAGEMENT
- Ventricular tachycardia
- - Key questions to consider
- - Evaluation
- - Treatment
- Symptomatic and high risk patients
- Patients with underlying CHD
- Asymptomatic patients without cardiac disease
- - Monitoring
- - Sports participation
- Supraventricular tachycardia
- SUMMARY AND RECOMMENDATIONS
- Initial management
- Chronic management