Differential Diagnosis of Supraventricular and Ventricular Tachycardia

Marriott, Henry J.L.

doi:10.1159/000174602

Cited by 27 publications

(21 citation statements)

References 15 publications

(33 reference statements)

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“…For patients with a predominantly positive QRS complex in V1, the presence of a qR, pure R, or RR′ complex makes VT more likely [11]. If the QRS complex has more than 1 peak, a higher first peak favors VT ( Figure 3) while a higher second peak does not; if the second peak is broad, however, supraventricular tachycardia with RBBB is favored [17].…”

Section: Precordial Qrs Complex Morphologymentioning

confidence: 99%

Life-Threatening Arrhythmias in the Intensive Care Unit

Reising

Kusumoto

Goldschlager

2007

J Intensive Care Med

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Symptomatic arrhythmias are frequently observed in the intensive care unit and often lead to significant hemodynamic compromise because of the presence of multisystem disease. In particular, prompt evaluation of patients with tachycardia is critical because treatment depends on the accurate diagnosis of the arrhythmia mechanism. The electrocardiogram remains the most important diagnostic tool for the evaluation of both wide complex and narrow complex tachycardia. For wide complex tachycardia, evaluation of the atrioventricular relationship and QRS morphology are critical, and for narrow QRS complex tachycardias, evaluation focuses on identification of the location and morphology of P waves. Bradycardia can arise from sinus node dysfunction or atrioventricular conduction block.

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Section: Precordial Qrs Complex Morphologymentioning

confidence: 99%

Life-Threatening Arrhythmias in the Intensive Care Unit

Reising

Kusumoto

Goldschlager

2007

J Intensive Care Med

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“…Marriott6 described that in RBBB shaped tachycardia, presence of a qR or R complex in lead V1 strongly argued for a ventricular origin of the tachycardia, while a three phasic (RSR) pattern suggested a supraventricular origin. Apart from lead V1, lead V6 can also be very helpful in correctly differentiating RBBB shaped tachycardia.…”

Section: The Ecg Diagnosismentioning

confidence: 99%

ELECTROPHYSIOLOGY: Ventricular tachycardia: diagnosis of broad QRS complex tachycardia

Wellens¹

2001

Heart

119

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W hen confronted with a tachycardia having a broad QRS complex, it is important to be able to diVerentiate between a supraventricular and a ventricular tachycardia. Medication given for the treatment of a supraventricular tachycardia (SVT) may be harmful to a patient with a ventricular tachycardia (VT).1 2 A reasonable haemodynamic condition during a tachycardia may erroneously lead to the wrong diagnosis of SVT.3 Familiarity with the ECG signs allowing the diagnosis of a VT is therefore essential. But as will be discussed here, the ECG should not only tell you how to distinguish VT from other tachycardias with a broad QRS complex, but also to suspect its aetiology and its site of origin in the ventricle. Both aspects are important in decision making about the prognostic significance of VT and correct treatment. Classification of tachycardias with a broad QRS complexAs shown in fig 1, broad QRS tachycardia can be divided in three groups. x SVT with bundle branch block-Bundle branch block (BBB) may be pre-existing or can occur when the refractory period of one of the bundle branches is reached because of the heart rate of the SVT (so called tachycardia related or phase 3 block). BBB can also occur because of retrograde invasion in one of the bundle branches. 4 These causes of BBB can be found in patients with atrial tachycardia, atrial flutter, atrial fibrillation, atrioventricular (AV) nodal tachycardia, and also during orthodromic circus movement tachycardia (with AV conduction over the AV node and ventriculo-atrial (VA) conduction over an accessory AV pathway).x SVT with AV conduction over an accessory AV pathway-This may occur during atrial tachycardia, atrial flutter, atrial fibrillation, AV nodal tachycardia, and during antidromic circus movement tachycardia (with AV conduction over an accessory AV pathway and VA conduction over the AV node or a second accessory AV pathway). It is also the case in the so called Mahaim tachycardia where AV conduction goes by way of a slowly conducting right sided accessory AV pathway or a nodo-ventricular fibre inserting into the right ventricle.

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“…Because most WCTs are either ventricular tachycardia (VT) or supraventricular tachycardia (SVT), conducted with fixed or functional BBB pattern, the clinically relevant problem in the differential diagnosis of WCTs is the differentiation of the latter two. 1 The ECG remains the cornerstone of distinguishing SVT from VT. A bewildering number of ECG criteria have been reported [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] for the differential diagnosis of regular WCTs. Using all these traditional ECG criteria, an accurate diagnosis is now possible in about 90% of WCTs.…”

Section: Introductionmentioning

confidence: 99%