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Approach to the Evaluation and Management of Wide Complex Tachycardias

Lam, Patrick and Saba, Samir (2002) Approach to the Evaluation and Management of Wide Complex Tachycardias. [Journal (Paginated)]

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Abstract

Wide complex tachycardia (WCT) refers to a cardiac rhythm of more than 100 beats per minute with a QRS duration of 120 ms or more on the surface electrocardiogram (ECG). It often presents a diagnostic dilemma for the physician particularly in determining its site of origin, which can be ventricular or supraventricular. In one series, only 32% of clinicians correctly diagnosed ventricular tachycardia (VT) in patients who presented with WCT1. Prompt diagnosis of the etiology of WCT is, however, essential since immediate care is frequently required. Diagnostic and therapeutic errors can produce poor outcome especially when ventricular tachycardia is not recognized.2,3 WCT that is grossly irregular typically represents atrial fibrillation with aberrant conduction or preexcitation. If its rate exceeds 200 beats per minute, the likelihood of atrial fibrillation with conduction over an accessory pathway should be entertained. In this article, we will discuss the approach to the evaluation and management of regular WCT.

Item Type:Journal (Paginated)
Keywords:Wide Complex Tachycardias
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4301
Deposited By: Indian Pacing and Electrophysiology, Journal
Deposited On:02 May 2005
Last Modified:11 Mar 2011 08:56

References in Article

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1. Akhtar M, Shenasa M, Jazayeri M et al: Wide complex tachycardia: reappraisal of a common problem. Ann Int Med. 1988;109; 905-912.

2. Buxton AE. Marchlinski FE. Doherty JU. Flores B. Josephson ME. Hazards of intravenous verapamil for sustained ventricular tachycardia. Am J Cardiol 1987;59:1107-1110.

3. Stewart RB, Bardy GH, Greene HL: Wide complex tachycardia: misdiagnosed and outcome after emergency therapy. Ann Intern Med 1986;104; 766-771.

4. Steinman RT, Herra C, Scuger CD, et al: Wide complex tachycardia in the conscious adult: Ventricular tachycardia is the most common cause. JAMA 1989;261: 1013-1016.

5. Morady F. Baerman JM. DiCarlo LA Jr. DeBuitleir M. Krol RB. Wahr DW. A prevalent misconception regarding wide-complex tachycardias. JAMA 1985;254:2790-2792.

6. Knight BP. Pelosi F. Michaud GF. Strickberger SA. Morady F. Physician interpretation of electrocardiographic artifact that mimics ventricular tachycardia. Am J Med 2001;110:335-338.

7. Knight BP. Pelosi F. Michaud GF. Strickberger SA. Morady F. Clinical consequences of electrocardiographic artifact mimicking ventricular tachycardia. N Engl J Med 1999;341(17):1270-1274.

8. Baerman JM. Morady F. DiCarlo LA Jr. de Buitleir M. Differentiation of ventricular tachycardia from supraventricular tachycardia with aberration: value of the clinical history. Annals of Emerg Med 1987;16:40-43.

9. Trochu P, Young P, Mahmud R, et al. Useful clinical criteria for the diagnosis of ventricular tachycardia. Am J Med 1988;84:53-56.

10. Garratt C, Griffith M, Young G, et al: Value of physical signs in the diagnosis of ventricular tachycardia. Circulation 1994;90: 3103-3107.

11. Rankin AC, Oldroyd KG, Chong E: Value and limitations of adenosine in the diagnosis and treatment of narrow and board complex tachycardia. Br Heart J 1981;46:679-682.

12. Grubb BP. Termination of ventricular tachycardia by carotid sinus stimulation. Int J Cardiol 1989;23, 397-399.

13. Waxman MB, Wald RW, Finley JP, et al. Valsalva termination of ventricular tachycardia. Circulation 1980;62: 834-851.

14. Lerman BB, Belardinelli L, West A et al. Adenosine-sensitive ventricular tachycardia. Evidence suggesting cyclic AMP-mediated triggered activity. Circulation 1986;74: 270-280.

15. Belhassen B, Rotmensch HH, Laniado S: Response of recurrent sustained ventricular tachycardia to verapamil. Br Heart J 1982;46:679-682.

16. Buxton AE. Marchlinski FE. Doherty JU. Flores B. Josephson ME. Hazards of intravenous verapamil for sustained ventricular tachycardia. Am J of Cardiol 1987; 59:1107-1110.

17. Haley JH. Reeder GS. Images in cardiovascular Medicine. Wide-complex tachycardia. Circulation 2000;102:E52.

18. Drew B, Scheinman M. ECG criteria to distinguish between aberrantly conducted supraventricular tachycardia and ventricular tachycardia. PACE 1995;18: 2194-2208.

19. Brugada P, Brugada J, Mont L. et al. A new approach to different diagnosis of a regular tachycardia with a wide QRS complex. Circulation 1991:83:1649-1659.

20. Lau E, Pathamanathan R, Ng A, et al: The Bayesian Approach Improves the Electrocardiographic Diagnosis of Board Complex Tachycardia. PACE 2000; 23: 1519-1526.

21. Wellen HJ, Bar FW, Lie K.: The value of the electrocardiogram in the differential diagnosis of a tachycardia with widened QRS complex. Am J Med 1978;64: 27-33.

22. Isenhour J, Craig S, Gibbs M, et al: Wide complex tachycardia: continued evaluation of diagnostic criteria. Acad Emerg Med 2000; 7: 769-773.

23. Zipes D, DiMario JD, Gillette PC, et al. Guidelines for clinical intracardiac electrophysiological and catheter ablation procedures. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Intracardiac Electrophysiologic and Catheter Ablation Procedures), developed in collaboration with the North American Society of Pacing and Electrophysiology. J am Coll Cardiol 1995;26:555-573.

24. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiac care. Circulation 2000; 102: I136-I165.

25. Coggins D, Lee R, Sweeney J, et al. Radiofrequecy catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin. J Am Coll Cardiol 1994;23: 1333-1341.

26. Tchou P, Jazayeri M, Denker S, et al. Transcatheter electrical ablation of right bundle branch: a method of treating macro-reentrant ventricular tachycardia due to bundle branch reentry. Circulation 1988;78:246.

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