Rhythm diagnosis in regular wide complex tachycardia

VTach vs. SVT

Factor	V Tach	SVT w/ Aberrancy
Age	>50	<35
History	MI, CHF, CABG, MVR	MVR, WPW
Cannon A Waves	Present	Absent
Arterial Pulse	Variation	No variation
First heart sound	Variable	Not variable
Fusion Beats	Present	Absent
AV dissociation	Present	Absent
QRS	>0.14sec	<0.14sec
Axis	Extreme LAD (< -30)	Normal or slightly abnl
Vagal Maneuvers	No response	Slows or terminates
QRS morphology V1 positive pattern	V1 - R or qR V6 - rS	V1 - RSR' V6 - Rs
QRS morphology V1 negative pattern	V1/V2 - Broad R wave (>40msec) V6 - Any Q or QS	V1/V2 - Small R V6 - no Q

Algorithm (Brugada Criteria)

• Only for regular rhythms
• Only for treatment decision if pt is stable
• Assume V-tach until proven otherwise

1. Absence of an RS complex in all precordial leads?
   1. If yes then VT
   2. If no then continue
2. R to S interval >100ms in one precordial lead?
   1. If yes then VT
   2. If no then continue
3. AV dissociation
   1. If yes then VT
   2. If no then continue
4. Morphology criteria for VT present both in V1-2 and V6?
   1. If yes then VT
   2. If no then possibly SVT

See Also

Tachycardia (Wide)

Source

7/2/09 Pani 4/2/10 Niemann