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1. Broad Complex
Tachyarrythmias

2. Key Points:
• Definition
• Classification
• ECG findings
• Management

3. Tachyarrhythmias:
• Tachyarrhythmias, defined as abnormal heart rhythms
with a ventricular rate of 100 or more beats per
minute.

5. Definition:
• Wide complex tachyarrhythmias refer to abnormal
heart rhythms characterized by a rapid heart rate
(tachyarrhythmia) and widened QRS complexes of
>120ms on an electrocardiogram (ECG).

6. Types of wide complex tachyarrythmias:
1. Ventricular Tachyarrythmias
a) Monomorphic VT single ectopic focus with consistent morphology of
QRS complex
b) Polymorphic VT multiple ectopic foci with some level of organized
electrical activity
c) Ventricular Fibrillation multiple ectopic foci with complete absence of
organized electrical activity
2. Supraventricular Tachyarrhythmias with Aberrant conduction
a) Atrial fibrillation with RBB or WPW Syndrome
a) Atrioventricular re- entrrant tachycardia (AVRT)

9. • Regular wide QRS complexes with identical morphology, p wave
absent or dissociated from QRS complex
• Broad Complex tachycardia originating from a single focus.
• Causes: IHD, Dilated and hypertrophic cardiomyopathy
• Presentation: If unstable may present with dyspnea, hypotension,
altered consciousness
• Monomorphic ventricular Tachycardia

10. • Characterized by a continuously changing QRS complex morphology
on ECG
• Causes: structural heart disease, electrolyte imbalances
(Hyperkalemia, hypomagnesemia), medication toxicity, and inherited
arrhythmia syndromes
• Presentation: palpitations, syncope, chest pain, hypotension,
dizziness
• Polymorphic ventricular tachycardia

11. Torsades de pointes:
• A type of polymorphic VT characterized on ECG by oscillatory changes
in amplitude of the QRS complexes around the isoelectric line.
• ECG : Prolonged QT Interval, beat-to-beat variability, Twisting pattern
of QRS complex .
• Causes: Electrolytes imbalance (hypokalemia, hypomagnesemia),
medications(antiarrhythmic class Ia and III, antibiotics etc )

13. Ventricular fibrillation :
• ECG Absent QRS complex, absent P waves, absent T wave and
presence of Fibrillatory waves

16. Ventricular Tachyarrhythmias Treatment:

17. SVT with Aberrancy:
• Originates above the ventricles (supraventricular), but the electrical
impulses conduct to the ventricles in an aberrant or abnormal
manner leading to wide QRS complexes on the ECG, mimicking
ventricular tachycardia (VT).

18. Afib with RBBB:
• The rhythm is irregularly irregular, so we have Atrial
Fibrillation
• The QRS complexes are wide with morphology consistent
with Right Bundle Brach Block (RBBB)
• The RBBB could be long-standing or caused by the Atrial
Fibrillation fast heart rate (Rate Related RBBB)

19. • Irregularly Irregular Rhythm
• Wide QRS cmplex
• Delta waves
• Absence of P waves
Afib with WPW:

20. Antidromic AVRT:
• In antidromic AVRT, anterograde conduction is via the
accessory pathway (AP).
• ECG: Wide QRS complex, Shortened PR Interval,
Absence of P waves, ST-T wave changes

21. Differentiation B/W VT and SVT with Aberrancy
Ventricular Tachycardia
1. Extreme axis deviation
2. AV dissociation is a specific
feature.
3. Refractory to vagal maneuvers
4. Risk factors: CAD,
Cardiomayopathy, MI
SVT with Aberrancy
1. No extreme axis deviation
2. AV dissociation is not a specific
feature.
3. Responds well to vagal
maneuvers
4. Risk factors: structural heart
disease, bundle branch block

22. SVT with Aberrancy Treatment
• Vagal maneuvers( Carotid sinus massage, Valsalva manuever)
• Medications Adenosine, beta blockers , Ca channel
blockers
• Electrical cardioversion in hemodynamically unstbable
patients
• Cather ablation