ECG Quest > Rhythms > Other Rhythms > Wide complex tachycardia

Wide complex tachycardia

A wide complex tachycardia is any rhythm that is fast (>100 bpm) with a wide QRS complex (>100 msec). These rhythms can originate from the ventricles, or they may be supraventricular with abnormal conduction through the ventricles (e.g. bundle branch blocks). Differentiating between these causes can be very complex and difficult.

If there are no clear normal P waves and the rhythm is regular, there are 4 main differentials:

  1. Ventricular tachycardia (80%)
  2. SVT with an old ventricular conduction delay (BBB or IVCD)
  3. SVT with aberrant conduction
  4. SVT related to Wolff Parkinson White syndrome.

Treatment depends on whether the patient is stable or unstable. If they are unstable, immediate cardioversion is needed.

See also: Other Rhythms

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References

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In the ECGquest archives, this ECG has been tagged with: - Tachycardia Wide QRS Change in rhythm Wide complex tachycardia Bifascicular block LAFB RBBB Positive Sgarbossa criteria 12-Lead Dr Smith's ECG Blog CC BY-NC
What is this rhythm? And what else does it show?

This ECG is from a man in his 60s who presented with abdominal pain dyspnoea and altered level of consciousness, in shock.

This ECG shows wide complex tachycardia with concordant ST elevation in V4-6, due to LAD occlusion. The rhythm was likely sinus tachycardia with RBBB and then LAFB mid way through the trace.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Regular Tachycardia Wide QRS Wide complex tachycardia Toxicology / Overdose 12-Lead Dr Smith's ECG Blog CC BY-NC
Wide-complex tachycardia: VT, aberrant, or “other?”

This ECG is from an older woman who presented with dyspnoea, diaphoresis and chest pressure. She had a background of paroxysmal AF for which she was on flecainide.

This ECG shows a regular wide complex tachycardia with possible flutter waves. There was no response to adenosine. The patient was electrically cardioverted. The cause was thought to be flecainide toxicity.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Palpitations Extreme tachycardia Left Axis Deviation Regular Tachycardia Wide QRS Wide complex tachycardia 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 13th August 2018 – Interpretation

This ECG is from a man in his 70s who presented with chest pain and palpitations on a background of hypertension and hypercholesterolaemia.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Tachycardia Fragmented QRS Wide QRS Wide complex tachycardia LBBB 12-Lead Serial 12-lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
Sudden Chest pain and SOB with a Wide Complex Tachycardia

This ECG is from a man in his 60s who presented with sudden onset severe chest pain and dyspnoea. He had no medical history or medications. On arrival he was in extremis with altered mentation, cyanosis and diaphoresis . There was no palpable radial pulse. Pulse oximetry read HR 170 and saturation 53%. This was the initial ECG.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Tachycardia Fragmented QRS Normal P waves Wide QRS Sinus tachycardia Wide complex tachycardia LBBB 12-Lead Serial 12-lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
Sudden Chest pain and SOB with a Wide Complex Tachycardia: Repeat after unsynchronised cardioversion

This ECG is from a man in his 60s who presented with sudden onset severe chest pain and dyspnoea. He had no medical history or medications. On arrival he was in extremis with altered mentation, cyanosis and diaphoresis . There was no palpable radial pulse. Pulse oximetry read HR 170 and saturation 53%. This was the repeat ECG after unsynchronised cardioversion.

In the ECGquest archives, this ECG has been tagged with: - Dizziness Dyspnoea Syncope Right Axis Deviation Tachycardia RSR' Wide QRS Wide complex tachycardia RBBB Pulmonary embolism 12-Lead Dr Smith's ECG Blog CC BY-NC
RBBB. Is there ST Elevation in III and aVR, with reciprocal ST depression in I and aVL?

This ECG is from a man of unknown age who presented with dizziness and dyspnoea on a background of stage 4 lymphoma. He was tachycardic, tachypnoeic (31) and hypoxic (SpO2 79%). The lungs were clear on auscultation.

In the ECGquest archives, this ECG has been tagged with: - Normal Axis Normal P waves Short PR Wide QRS Wide complex tachycardia LBBB 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 1st January 2018 – Interpretation 2

This ECG is from a woman in her 20s with a known history of pre-excitation and prior ablation.

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