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==Overview==
==Overview==
A wide complex tachycardia is either of ventricular origin ([[ventricular tachycardia]] or [[VT]]), of supraventricular origin with aberrant conduction ([[SVT]] with aberrancy), of supraventricular origin and is conducted down a [[bypass tract]] such as in [[Wolff-Parkinson-White syndrome]] ([[WPW]]), or is due to a pacemaker malfunction.  The most common cause of [[wide complex tachycardia]] ([[WCT]]) is [[ventricular tachycardia]] ([[VT]]), which accounts for 80% of all cases of [[WCT]].<ref name="pmid16951728">{{cite journal |author=Lam P, Saba S |title=Approach to the evaluation and management of wide complex tachycardias |journal=[[Indian Pacing and Electrophysiology Journal]] |volume=2 |issue=4 |pages=120–6 |year=2002 |pmid=16951728 |pmc=1557420 |doi= |url=http://www.ipej.org/2/120 |issn= |accessdate=2013-08-04}}</ref><ref name="pmid11233948">{{cite journal| author=Gupta AK, Thakur RK| title=Wide QRS complex tachycardias. | journal=Med Clin North Am | year= 2001 | volume= 85 | issue= 2 | pages= 245-66, ix-x | pmid=11233948 | doi= | pmc= | url= }} </ref>  [[Supraventricular tachycardia]] (SVT) with aberrancy accounts for 15% to 20% of WCTs.  SVTs with [[preexcitation]] and [[antidromic atrioventricular reentrant tachycardia]] ([[AVRT]]) account for 1% to 6% of WCTs.<ref name='book1'>Issa Z, Miller JM, Zipes DP(2009). Approach to Wide QRS Complex Tachycardias. '' Arrhythmology and Electrophysiology:
A wide complex tachycardia (WCT) is either of ventricular origin ([[ventricular tachycardia]]), of supraventricular origin with aberrant conduction ([[SVT]] with aberrancy), of supraventricular origin and is conducted down a [[bypass tract]] such as in [[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White syndrome (WPW)]], or is due to a pacemaker malfunction.  The most common cause of WCT is [[ventricular tachycardia|ventricular tachycardia (VT)]], which accounts for 80% of all cases of WCT.<ref name="pmid16951728">{{cite journal |author=Lam P, Saba S |title=Approach to the evaluation and management of wide complex tachycardias |journal=[[Indian Pacing and Electrophysiology Journal]] |volume=2 |issue=4 |pages=120–6 |year=2002 |pmid=16951728 |pmc=1557420 |doi= |url=http://www.ipej.org/2/120 |issn= |accessdate=2013-08-04}}</ref><ref name="pmid11233948">{{cite journal| author=Gupta AK, Thakur RK| title=Wide QRS complex tachycardias. | journal=Med Clin North Am | year= 2001 | volume= 85 | issue= 2 | pages= 245-66, ix-x | pmid=11233948 | doi= | pmc= | url= }} </ref>  [[Supraventricular tachycardia|Supraventricular tachycardia (SVT)]] with aberrancy accounts for 15% to 20% of WCTs.  SVTs with [[preexcitation]] and [[AV reentrant tachycardia#Retrograde Reentrant Tachycardia|antidromic atrioventricular reentrant tachycardia]] account for 1% to 6% of WCTs.<ref name='book1'>Issa Z, Miller JM, Zipes DP(2009). Approach to Wide QRS Complex Tachycardias. '' Arrhythmology and Electrophysiology:
A Companion to Braunwald's heart disease'' (1st ed., pp. 393). Philadelphia, Pa: Saunders Elsevier.</ref>
A Companion to Braunwald's heart disease'' (1st ed., pp. 393). Philadelphia, Pa: Saunders Elsevier.</ref>


==Ventricular Tachycardia==
==Causes==
Common causes of ventricular tachycardia include [[ischemic heart disease]], illicit drugs ([[cocaine]] and [[methamphetamine]]), [[structural heart disease]] (including [[congenital heart disease]]s such as [[tetralogy of Fallot]]), inherited [[channelopathies]], [[drug toxicity]] ([[digoxin]], drugs that [[prolong the QT interval]]) and [[electrolyte disturbances]] (such as [[hypokalemia]], [[hypomagnesemia]], and [[hypocalcemia]]).
===Ventricular Tachycardia Causes===
====Life Threatening Causes====
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.


===Causes===
===Common Causes===
====Across All Ages====
*[[Congestive heart failure]]
*[[Hypokalemia]]
*[[Hypomagnesemia]]
*[[STEMI]]
*[[STEMI]]
*[[Unstable angina]]


====Among Patients Under 35 Years of Age====
====Common Causes====  
*[[Arrhythmogenic right ventricular dysplasia]]
*[[AV reentrant tachycardia]]
*[[Hypertrophic cardiomyopathy]]
*[[Pre-excitation syndrome]]
*[[Long QT syndrome]]
*[[Supraventricular tachycardia]]
*[[Myocarditis]]
*[[Ventricular tachycardia]]
*[[Short QT syndrome]]
* [[Short QT syndrome type 1]]
* [[Short QT syndrome type 2]]
* [[Short QT syndrome type 3]]
* [[Short QT syndrome type 4]]
* [[Short QT syndrome type 5]]


===Causes by Organ System===
====Causes by Organ System====
{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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|}
|}


===Causes in Alphabetical Order===
====Causes in Alphabetical Order====
{{col-begin|width=80%}}
{{columns-list|
{{col-break|width=33%}}
*[[Acid-base disturbances]]
*[[Acid-base disturbances]]
*[[Acidosis]]
*[[Acidosis]]
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*[[Droperidol]]
*[[Droperidol]]
*[[Electrolyte imbalance]]
*[[Electrolyte imbalance]]
{{col-break|width=33%}}
*[[Electrophysiologic studies]]
*[[Electrophysiologic studies]]
*[[Eribulin mesylate]]
*[[Eribulin mesylate]]
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*[[Pimozide]]
*[[Pimozide]]
*[[Piperaquine]]
*[[Piperaquine]]
{{col-break|width=33%}}
*[[Prenylamine]]
*[[Prenylamine]]
*[[Probucol]]
*[[Probucol]]
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*[[Zotepine]]
*[[Zotepine]]
*[[Zuclopenthixol]]
*[[Zuclopenthixol]]
{{col-end}}
}}


==Supraventricular Tachycardia==
====Causes Across All Ages====
*[[Congestive heart failure]]
*[[Hypokalemia]]
*[[Hypomagnesemia]]
*[[STEMI]]
 
====Causes Among Patients Under 35 Years of Age====
*[[Arrhythmogenic right ventricular dysplasia]]
*[[Hypertrophic cardiomyopathy]]
*[[Long QT syndrome]]
*[[Myocarditis]]
*[[Short QT syndrome]]
* [[Short QT syndrome type 1]]
* [[Short QT syndrome type 2]]
* [[Short QT syndrome type 3]]
* [[Short QT syndrome type 4]]
* [[Short QT syndrome type 5]]
 
===Supraventricular Tachycardia===
* [[Supraventricular tachycardia]] ([[SVT]]) with aberrant ventricular conduction is either new or due to a preexisting left or right [[bundle branch block]] or a preexisting nonspecific [[intraventricular conduction delay]] ([[IVCD]]).  The underlying supraventricular rhythm that is aberrantly conducted can be any one of the following rhythms:
* [[Supraventricular tachycardia]] ([[SVT]]) with aberrant ventricular conduction is either new or due to a preexisting left or right [[bundle branch block]] or a preexisting nonspecific [[intraventricular conduction delay]] ([[IVCD]]).  The underlying supraventricular rhythm that is aberrantly conducted can be any one of the following rhythms:
:* [[Atrial flutter]] with 2:1 conduction and occasional 1:1 conduction
:* [[Atrial flutter]] with 2:1 conduction and occasional 1:1 conduction
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Electrophysiology]]
[[Category:Electrophysiology]]
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[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:Crowdiagnosis]]
{{WH}}
{{WS}}

Latest revision as of 19:28, 10 January 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A wide complex tachycardia (WCT) is either of ventricular origin (ventricular tachycardia), of supraventricular origin with aberrant conduction (SVT with aberrancy), of supraventricular origin and is conducted down a bypass tract such as in Wolff-Parkinson-White syndrome (WPW), or is due to a pacemaker malfunction. The most common cause of WCT is ventricular tachycardia (VT), which accounts for 80% of all cases of WCT.[1][2] Supraventricular tachycardia (SVT) with aberrancy accounts for 15% to 20% of WCTs. SVTs with preexcitation and antidromic atrioventricular reentrant tachycardia account for 1% to 6% of WCTs.[3]

Causes

Ventricular Tachycardia Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Acute coronary syndrome, Andersen cardiodysrhythmic periodic paralysis, arrhythmogenic right ventricular dysplasia, AV block, cardiomyopathy, catecholaminergic polymorphic ventricular tachycardia, congenital heart disease, congestive heart failure, hypertrophic cardiomyopathy, ischaemic heart disease, Jervell and Lange-Nielsen syndrome, long QT Syndrome, myocardial Infarction, myocarditis, NSTEMI, right ventricular outflow tract tachycardia, Romano-Ward syndrome, short QT syndrome, short QT syndrome type 1, short QT syndrome type 2, short QT syndrome type 3, short QT syndrome type 4, short QT syndrome type 5, STEMI, Timothy syndrome, torsade de pointes, unstable angina, valvular heart disease, ventricular aneurysm, Wolff-Parkinson-White syndrome
Chemical / poisoning Arsenic trioxide, arsenicals
Dermatologic No underlying causes
Drug Side Effect Alimemazine, almokalant, amiodarone, amitriptyline, amphetamines, antiarrhythmics, asenapine, astemizole, azimilide, azithromycin, bepridil, bretylium, budipine, chloroquine, cibenzoline, cisapride, citalopram, clomipramine, clozapine, cocaine, crizotinib, desipramine, digitalis, diphenhydramine, disopyramide, dofetilide, dolasetron, doxepin, dronedarone, droperidol, eribulin mesylate, fluconazole, grepafloxacin, halofantrine, haloperidol, ibutilide, imipramine, indapamide, inotropes, ketanserin, ketoconazole, lidoflazine, lubeluzole, methadone, methadyl acetate, methamphetamine, midodrine, mizolastine, moxifloxacin, naratriptan, nicardipine, nilotinib, ondansetron, pasireotide, pazopanib, pentamidine, phenothiazines, pimozide, piperaquine, prenylamine, probucol, procainamide, propoxyphene, quinidine, quinine, ranolazine, retigabine, ritodrine, ritonavir, saquinavir, sertindole, sotalol, sparfloxacin, sympathomimetic agents, tedisamil, telithromycin, terfenadine, terodiline, tetrabenazine, thioridazine, vandetanib, vemurafenib, venlafaxine, vernakalant, voriconazole, vorinostat, ziprasidone, zotepine, zuclopenthixol
Ear Nose Throat No underlying causes
Endocrine Hyperthyroidism, hypothyroidism, pheochromocytoma
Environmental Hypothermia, zero gravity
Gastroenterologic No underlying causes
Genetic Channelopathies, myotonic dystrophy, Andersen cardiodysrhythmic periodic paralysis, Jervell and Lange-Nielsen syndrome, Romano-Ward syndrome, short QT syndrome type 1, short QT syndrome type 2, short QT syndrome type 3, short QT syndrome type 4, short QT syndrome type 5, Timothy syndrome
Hematologic No underlying causes
Iatrogenic Cardioversion, defibrillation, electrophysiologic studies, heart surgery, pulmonary artery catheter , right heart catheterisation
Infectious Disease No underlying causes
Musculoskeletal / Ortho Andersen cardiodysrhythmic periodic paralysis, Timothy syndrome, myotonic dystrophy
Neurologic No underlying causes
Nutritional / Metabolic Acidosis, acid-base disturbances, acute starvation, electrolyte imbalance, hyperkalaemia, hypocalcemia, hypoglycaemia, hypokalemia, hypomagnesemia
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity Alimemazine, almokalant, amiodarone, amitriptyline, amphetamines, antiarrhythmics, asenapine, astemizole, azimilide, azithromycin, bepridil, bretylium, budipine, chloroquine, cibenzoline, cisapride, citalopram, clomipramine, clozapine, cocaine, crizotinib, desipramine, digitalis, diphenhydramine, disopyramide, dofetilide, dolasetron, doxepin, dronedarone, droperidol, eribulin mesylate, fluconazole, grepafloxacin, halofantrine, haloperidol, ibutilide, imipramine, indapamide, inotropes, ketanserin, ketoconazole, lidoflazine, lubeluzole, methadone, methadyl acetate, methamphetamine, midodrine, mizolastine, moxifloxacin, naratriptan, nicardipine, nilotinib, ondansetron, pasireotide, pazopanib, pentamidine, phenothiazines, pimozide, piperaquine, prenylamine, probucol, procainamide, propoxyphene, quinidine, quinine, ranolazine, retigabine, ritodrine, ritonavir, saquinavir, sertindole, sotalol, sparfloxacin, sympathomimetic agents, tedisamil, telithromycin, terfenadine, terodiline, tetrabenazine, thioridazine, vandetanib, vemurafenib, venlafaxine, vernakalant, voriconazole, vorinostat, ziprasidone, zotepine, zuclopenthixol
Psychiatric Anorexia nervosa, starvation
Pulmonary Hypoxia, obstructive sleep apnea, sleep apnea
Renal / Electrolyte Acidosis, acid-base disturbances, acute starvation, electrolyte imbalance, hyperkalaemia, hypocalcemia, hypoglycaemia, hypokalemia, hypomagnesemia
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma Myocardial contusion
Urologic No underlying causes
Dental No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Causes Across All Ages

Causes Among Patients Under 35 Years of Age

Supraventricular Tachycardia

Pre-Excitation Syndrome

The diagnosis of rapid antegrade conduction down a bypass tract due to ventricular pre-excitation such as Wolff-Parkinson-White syndrome (WPW) should be considered if

Paced Rhythms

A paced rhythm as a cause of wide complex tachycardia is infrequent. This diagnosis is suggested in the following scenarios:

  • A pacemaker is in place and there is a LBBB pattern with superior left axis deviation, however, depending on the site of pacing this pattern can vary significantly
  • A wide complex tachycardia is due to an SVT and the pacemaker is tracking sensed atrial activity and is pacing the ventricles rapidly as result
  • Pacemaker-mediated tachycardia in which there is retrograde conduction which triggers atrial activity during ventricular pacing
  • Runaway pacemaker syndrome in which the pacemaker fires at a rate of nearly 2000 bpm and captures intermittently
  • Sensor induced tachycardia in which case the pacemaker fires at a rate of nearly 160-180 bpm in response to electrocautery, noise, vibration, limb movement or other stimuli

References

  1. ↑ Lam P, Saba S (2002). "Approach to the evaluation and management of wide complex tachycardias". Indian Pacing and Electrophysiology Journal. 2 (4): 120–6. PMC 1557420. PMID 16951728. Retrieved 2013-08-04.
  2. ↑ Gupta AK, Thakur RK (2001). "Wide QRS complex tachycardias". Med Clin North Am. 85 (2): 245–66, ix–x. PMID 11233948.
  3. ↑ Issa Z, Miller JM, Zipes DP(2009). Approach to Wide QRS Complex Tachycardias. Arrhythmology and Electrophysiology: A Companion to Braunwald's heart disease (1st ed., pp. 393). Philadelphia, Pa: Saunders Elsevier.

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