Contributor: Travis Barlock MD

Educational Pearls:

Wide-complex tachycardia is defined as a heart rate > 100 BPM with a QRS width > 120 milliseconds
Wide-complex tachycardia of supraventricular origin is known as SVT with aberrancy

Aberrancy is due to bundle branch blocks
Mostly benign
Treated with adenosine or diltiazem

Wide-complex tachycardia of ventricular origin is also known as VTach

Originates from ventricular myocytes, which are poor inherent pacemakers
Dangerous rhythm that can lead to death
Treated with amiodarone or lidocaine

80% of wide-complex tachycardias are VTach

90% likelihood for patients with a history of coronary artery disease

In assessing a wide-complex tachycardia, it is best to treat it as a presumed ventricular tachycardia

Treating SVT with amiodarone or lidocaine does no harm
However, treating VTach with adenosine or diltiazem may worsen the condition

References

1. Littmann L, Olson EG, Gibbs MA. Initial evaluation and management of wide-complex tachycardia: A simplified and practical approach. Am J Emerg Med. 2019;37(7):1340-1345. doi:https://doi.org/10.1016/j.ajem.2019.04.027

2. Viskin S, Chorin E, Viskin D, Hochstadt A, Schwartz AL, Rosso R. Polymorphic Ventricular Tachycardia: Terminology, Mechanism, Diagnosis, and Emergency Therapy. Circulation. 2021;144(10):823-839. doi:10.1161/CIRCULATIONAHA.121.055783

3. Williams SE, O'Neill M, Kotadia ID. Supraventricular tachycardia: An overview of diagnosis and management. Clin Med J R Coll Physicians London. 2020;20(1):43-47. doi:10.7861/clinmed.cme.20.1.3

Summarized by Jorge Chalit, OMSIII | Edited by Meg Joyce & Jorge Chalit

Episode 907: Wide-Complex Tachycardia