This document discusses wide complex tachycardia (WCT), which is ventricular in origin 80% of the time. In patients with structural heart disease, 95% of WCT is ventricular tachycardia (VT). VT can be life-threatening and cause sudden death or tachycardia-induced cardiomyopathy. The document describes types of VT based on morphology and duration, symptoms of VT, features that appear on ECGs during VT like abnormal wide QRS complexes and AV dissociation, and examples of patients presenting with potential VT.

1. WIDE COMPLEX
TACHYCARDIA
19/01/2012
Omer Abu-Bakr M. El-Amin, MD, FACC

2. Tachycardia
Narrow Complex Wide Complex
Regular Irregular Regular Irregular
Atrial Atrial fib +
SVT Atrial VT SVT
Tachycardia MAT AP
fibrillation
AVNRT Atrial Flutter
AVRT

3. Probability of Origin
• 80% of all wide complex tachycardia (WCT) is of
ventricular origin (VT)
• In patients with structural heart disease, 95% of all WCT
is VT

4. Clinical Significance
• Potentially life-threatening (sudden death)
• Tachycardia-induced cardiomyopathy
• VT vs SVT
• Prognosis
• Management

5. Symptoms
• Palpitations
• Syncope
• Low output symptoms
• Sudden death
• CHF

6. Types of VT
• Morphology:
• Monomorphic
• Polymorphic
• Duration:
• Sustained (>30 sec)
• Non-sustained (<30 sec)

7. Features of VT
• Abnormal and wide QRS
• The rate is usually 140 – 200 bpm
• It is usually regular
• Abrupt onset and termination
• AV dissociation
• Capture beat
• Fusion beat

9. ECG RECOGNITION OF VT

10. Important Clues/Identifiers
• Rhythm regularity
• QRS concordance in precordial leads
• AV dissociation
• BBB morphology
• QRS axis

14. 24-year-old female with peripartum
cardiomyopathy and palpitations

16. 68-year-old male in the emergency room with
palpitations and syncope

19. 26 year old male with palpitations and
dizziness