Rhythm diagnosis in regular wide complex tachycardia

Brugada's Criteria

1. Lack of precordial RS complex. yes=VT
2. R onset to S nadir > 100ms of 2.5 sm boxes in one precordial lead. yes=VT
3. AV dissociation. yes=VT
4. Morphology criteria for VT present both in precordial leads v1-2 and v6. yes-VT

VTach vs. SVT

V TACH

1. age >50
2. h/o MI, CHF, CABG, ASHD, mitral valve prolapse, prev v tach
3. cannon A waves
4. variation in arterial pulse
5. variable first heat sound
6. fusion beats
7. AV dissociation
8. QRS > 0.14sec
9. extreme LAD <-30degree
10. no response to vagal maneuvers
11. specific QRS pattern- V1- R, qR or RS, V6- S, rS or qR
12. concordance

SVT With Aberrancy

1. age <35
2. mitral valve prolapse, esp c h/o WPW
3. prev SVT
4. no cannon A waves
5. no variability in arterial pulse
6. no variability of first heart sound
7. no fusion beats
8. p waves preceding qrs cmplx
9. QRS usually <0.14 sec
10. axis normal or slightly abnormal
11. slow or terminate with vagal maneuver
12. specific QRS pattern- V1-rsR', V6qRs (R wave in V1 or V2 < 1 box wide)
13. In Peds SVT w/ Aberrancy = #1 cause of wide tachycardia

See Also

Tachycardia (Wide)

Source

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