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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 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> | ||
===Causes=== | ===Causes=== | ||
=== | ===Life Threatening Causes=== | ||
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. | |||
*[[STEMI]] | *[[STEMI]] | ||
*[[Unstable angina]] | |||
==== | ===Common Causes=== | ||
*[[AV reentrant tachycardia]] | |||
*[[Pre-excitation syndrome]] | |||
*[[Supraventricular tachycardia]] | |||
*[[Ventricular tachycardia]] | |||
* [[ | |||
* [[ | |||
* [[ | |||
* [[ | |||
===Causes by Organ System=== | ===Causes by Organ System=== | ||
| Line 156: | Line 145: | ||
===Causes in Alphabetical Order=== | ===Causes in Alphabetical Order=== | ||
{{ | {{columns-list|3| | ||
*[[Acid-base disturbances]] | *[[Acid-base disturbances]] | ||
*[[Acidosis]] | *[[Acidosis]] | ||
| Line 207: | Line 195: | ||
*[[Droperidol]] | *[[Droperidol]] | ||
*[[Electrolyte imbalance]] | *[[Electrolyte imbalance]] | ||
*[[Electrophysiologic studies]] | *[[Electrophysiologic studies]] | ||
*[[Eribulin mesylate]] | *[[Eribulin mesylate]] | ||
| Line 258: | Line 245: | ||
*[[Pimozide]] | *[[Pimozide]] | ||
*[[Piperaquine]] | *[[Piperaquine]] | ||
*[[Prenylamine]] | *[[Prenylamine]] | ||
*[[Probucol]] | *[[Probucol]] | ||
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*[[Zotepine]] | *[[Zotepine]] | ||
*[[Zuclopenthixol]] | *[[Zuclopenthixol]] | ||
}} | |||
====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== | ||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[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}} | |||
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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
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- AV reentrant tachycardia
- Pre-excitation syndrome
- Supraventricular tachycardia
- Ventricular tachycardia
Causes by Organ System
Causes in Alphabetical Order
The unnamed parameter 2= is no longer supported. Please see the documentation for {{columns-list}}.
3Causes Across All Ages
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:
- Atrial flutter with 2:1 conduction and occasional 1:1 conduction
- Automatic junctional tachycardia
- AV nodal reentrant tachycardia
- AV reentrant tachycardia using a bypass tract
- Intraatrial reentrant tachycardia
- Paroxysmal atrial tachycardia
- SA nodal reentrant tachycardia
- Sinus 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
- There is intermittent present of a delta wave
- There is intermittently a short PR interval
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
- ↑ 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.
- ↑ Gupta AK, Thakur RK (2001). "Wide QRS complex tachycardias". Med Clin North Am. 85 (2): 245–66, ix–x. PMID 11233948.
- ↑ 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.