Contents

Search

wide complex tachycardia

Wide complex tachycardias may occur as a result of initial supraventricular or ventricular depolarizations. Identification of the origin of the initial depolarization is important in selection of the appropriate management of the patient. Etiology: 1) ventricular tachycardia (most common) 2) supraventricular tachycardias (SVT): a) SVTs associated with bundle-branch block b) Wolf-Parkinson-White (WPW) Special laboratory: 1) electrocardiogram, establish the rhythm 2) electrophysiologic testing after restoration of sinus rhythm 3) saO2 Management: 1) treat as ventricular tachycardia until proven otherwise - adenosine may be given for stable wide complex tachycardia to determine with it is supraventricular tachycardia (SVT) vs ventricular tachycardia (SVT will respond to adenosine) [2] 2) unstable patients - immediate synchronized cardioversion 3) stable patients with suspected supraventricular tachycardia a) adenosine 6 mg IV, followed by 12 mg IV if no effect b) carotid sinus massage 4) pharmaceutical agents a) beta-blocker for atrial fibrillation with bundle branch block b) amiodarone 150 mg IV over 10 min for ventricular tachycardia - repeat as needed to maximum dose of 2.2 g/24 hours c) chemical cardioversion - procainamide is the agent of choice for chemical cardioversion of ventricular tachycardia except in the setting of acute MI or digoxin toxicity; in these cases, lidocaine remains the agent of choice; procainamide may also terminate supraventricular arrhythmias d) consider sedative (benzodiazpeine, barbiturate) with or without analgesic (opiate) 5) at bedside: a) suction device b) IV line c) setup for endotracheal intubation 6) inpatient monitoring following restoration of sinus rhythm

Related

Wolff-Parkinson-White (WPW) syndrome

Specific

accelerated idioventricular rhythm (AIVR) ventricular tachycardia (VT)

General

tachyarrhythmia (tachycardia)

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 146-50, 181
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17. American College of Physicians, Philadelphia 1998, 2012, 2015
  3. Goldberger ZD, Rho RW, Page RL. Approach to the diagnosis and initial management of the stable adult patient with a wide complex tachycardia. Am J Cardiol. 2008 May 15;101(10):1456-66 PMID: 18471458