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Challenges in Clinical Electrocardiography
June 10, 2013

Wide-Complex Tachycardia in a Patient With Coronary Disease—Diagnosis

Author Affiliations
 

SECTION EDITORS: JEFFREY TABAS, MD; PAUL D. VAROSY, MD; GREGORY M. MARCUS, MD; NORA GOLDSCHLAGER, MD

JAMA Intern Med. 2013;173(11):951-952. doi:10.1001/jamainternmed.2013.109b

The differential diagnosis of wide-complex tachycardia includes VT, a supraventricular tachycardia (SVT) with aberrancy, a preexcited tachycardia with anterograde conduction occurring over an accessory pathway, ventricular pacing, or QRS widening owing to an antiarrhythmic drug or electrolyte effect. The QRS complexes in the 12-lead ECG in Figure 1 show an atypical right bundle branch block QRS morphology with a right-inferior axis. There is no obvious evidence of atrioventricular (AV) dissociation. The positively concordant QRS complexes, the atypical notched monophasic R wave in lead V1, and the clinical scenario of ischemic heart disease all favor VT as the diagnosis. Published criteria by Brugada et al1 and Verecki et al2,3 are useful in the diagnosis of wide-complex rhythms and also support a diagnosis of VT in this patient.

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