Wide complex tachycardia causes
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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
- AV reentrant tachycardia
- Pre-excitation syndrome
- Supraventricular tachycardia
- Ventricular tachycardia
Causes by Organ System
Causes in Alphabetical Order
Causes 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.