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

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 al^2,3 are useful in the diagnosis of wide-complex rhythms and also support a diagnosis of VT in this patient.