Difference between revisions of "Approach to the Wide Complex Tachycardia"

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During wide complex tachycardia (heart rate > 100/min, QRS > 0.12 sec) the differentiation between supraventricular and ventricular origin of the arrhythmia is important to guide therapy. Several algorhythms have been developed to aid in this differentiation (below). It is important to keep in mind that a good estimate of VT ''versus'' SVT can be made based on the clinical vignette:
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During wide complex tachycardia (heart rate > 100/min, QRS > 0.12 sec) the differentiation between supraventricular and ventricular origin of the arrhythmia is important to guide therapy. Several algorithms have been developed to aid in this differentiation (below). It is important to keep in mind that a good estimate of VT ''versus'' SVT can be made based on the clinical vignette:
 
* 'Horizontal entrance' into the ER. Older patient with previous myocardial infarction = most likely VT
 
* 'Horizontal entrance' into the ER. Older patient with previous myocardial infarction = most likely VT
 
* Younger patient with known paroxysmal tachycardias and who is hemodynamically stable = most like SVT
 
* Younger patient with known paroxysmal tachycardias and who is hemodynamically stable = most like SVT
== The ACC algorhythm <cite>ACC</cite>==
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== The ACC algorithm <cite>ACC</cite>==
[[File:VT_algorythm_en.png|800px|thumb|left|SVT vs VT algorhytm. Adapted from <cite>ACC</cite>]]
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[[File:VT_algorithm_en.png|800px|thumb|left|SVT vs VT algorhytm. Adapted from <cite>ACC</cite>]]
 
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Revision as of 22:20, 27 January 2010

During wide complex tachycardia (heart rate > 100/min, QRS > 0.12 sec) the differentiation between supraventricular and ventricular origin of the arrhythmia is important to guide therapy. Several algorithms have been developed to aid in this differentiation (below). It is important to keep in mind that a good estimate of VT versus SVT can be made based on the clinical vignette:

  • 'Horizontal entrance' into the ER. Older patient with previous myocardial infarction = most likely VT
  • Younger patient with known paroxysmal tachycardias and who is hemodynamically stable = most like SVT

The ACC algorithm [1]

File:VT algorithm en.png
SVT vs VT algorhytm. Adapted from [1]


Brugada criteria

Brugada algorithm.png
Morphological criteria (if the above criteria are inconclusive)
LBBB pattern
Initial R more than 40ms? Yes => VT
Rhythm RSratio.png
Slurred or notched downwards leg of S wave in leads V1 or V2 Yes => VT
Beginning of Q to nadir QS >60 ms in V1 or V2? Yes => VT LR >50:1
Q or QS in V6? Yes => VT LR >50:1
Rhythm LBTBmorph nl.png
RBBB pattern
Monofasic R or qR in V1? Yes => VT
R taller than R' (rabbit-ear sign)? Yes => VT LR >50:1
rS in V6? Yes => VT LR >50:1
Rhythm RBTBmorph nl.png


Vereckei algorithm [2]

Vereckei algorithm.png
If the distance traveled on the Y axis in the initial 40ms of the QRS complex is smaller than that traveled in the terminal 40ms of the QRS complex, a VT is much more likely


Examples

Referenties

Error fetching PMID 14563598:
Error fetching PMID 2022022:
Error fetching PMID 17272358:
  1. Error fetching PMID 14563598: [ACC]
  2. Error fetching PMID 17272358: [Vereckei]
  3. Error fetching PMID 2022022: [Brug1]

All Medline abstracts: PubMed | HubMed