Episode 907: Wide-Complex Tachycardia

Emergency Medical Minute

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