Wide complex tachycardia

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Wide complex tachycardia
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WCT Principles of Differentiation

• Clinical judgment patient and his heart disease
• Basic ECG
• Conduction abnormality?
• WPW?
• Signs of old MI or Cardiomiopathy
• VT has to be wide complex
• SVT could be wide complex (aberrant conduction,
  pre-excitation)
• AV dissociation always means VT and exists in 80
  of VTs
• AV association may be antegrade (SVT) or
  retrograde (VT)

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ECG Diagnosis of WCT

• Evidence of AV dissociation
• P waves marching through tachycardia
• Fusion beats
• Capture beats
• May use maneuvers to amplify P waves
• Lewis leads
• Esophageal ECG
• Various morphology criteria

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Esophageal recording for VT diagnosis
Surface
Esophageal
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Case presentation

• 63 yo gentleman
• Palpitations, dizziness, weakness for one week
• No previous medical history
• After ECG was obtained - send to ER susp MI
• In ER PS 160, BP 80/50
• Adenosine not converted,
• Amiodarone no response
• Cardioversion failed ---- called EP consult

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Esophageal ECG

• 11 AV (VA??) conduction

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Next diagnostic step

• Another attempt of cardioversion
• More amiodarone IV
• Adenosine with esophageal recording
• Endocardial recording/ EPS
• Complete blood count

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ADENOSINE IV esophageal ECG
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• EP consult conclusion
• Right atrial ectopic (or sinus) tachycardia
• CBC Hb 8 mg/dl ...
• Diagnosis at discharge Renal cell tumor