{"id":187,"date":"2008-10-03T08:58:31","date_gmt":"2008-10-03T08:58:31","guid":{"rendered":"http:\/\/cardiophile.org\/?p=187"},"modified":"2022-08-22T20:56:30","modified_gmt":"2022-08-22T15:26:30","slug":"wide-qrs-tachycardia","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/","title":{"rendered":"Wide QRS tachycardia"},"content":{"rendered":"

Wide QRS tachycardia<\/span><\/h1>\n

\"wqt\"<\/a><\/p>\n

Wide QRS Tachycardia<\/em><\/p>\n

Electrocardiographic recognition of ventricular tachycardia (VT) by the presence of:<\/strong><\/p>\n

    \n
  1. \n
      \n
    1. A V dissociation – P waves randomly distributed<\/span><\/span><\/span><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n
        \n
      1. \n
          \n
        1. Capture beats and fusion beats<\/span><\/span><\/span><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n
            \n
          1. Monomorphic with concordant QRS pattern in chest leads<\/span><\/span><\/span><\/li>\n<\/ol>\n

            Sustained<\/strong> vs Nonsustained\u00a0VT:<\/strong><\/p>\n

            Sustained > 30 sec<\/span><\/span><\/span><\/p>\n

            Non-sustained at least 6 beats, but less than 30 sec<\/span><\/span><\/span><\/p>\n

            Types of <\/span><\/span><\/span>LVOT VT:\u00a0supracuspal vs infracuspal<\/span><\/span><\/span><\/p>\n

            Mechanisms of VT:<\/strong><\/p>\n

              \n
            1. \n
                \n
              1. Re-entrant: Types of re-entrant circuits: Anatomic, functional, anisotropic<\/span><\/span><\/span><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n
                  \n
                1. \n
                    \n
                  1. Automatic<\/span><\/span><\/span><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n
                      \n
                    1. Triggered activity – <\/span><\/span><\/span>Early after depolarisation and Delayed after depolarisation<\/span><\/span><\/span><\/li>\n<\/ol>\n

                      Identification of VT – Tips<\/strong><\/p>\n

                      Septal VT has a relatively narrower QRS<\/span><\/span><\/span><\/p>\n

                      If the QRS complex in tachycardia is narrower than in sinus rhythm it favors ventricular tachycardia originating from ventricle with the blocked bundle branch.<\/span><\/span><\/span><\/p>\n

                      Concordant QRS in chest leads – <\/span><\/span><\/span>Negative concordance in apical origin; <\/span><\/span><\/span>Positive concordance in basal origin<\/span><\/span><\/span><\/p>\n

                      LBBB pattern – RV or LV septum<\/span><\/span><\/span><\/p>\n

                      RBBB –\u00a0LV origin; <\/span><\/span><\/span>RBBB pattern with abrupt loss of R wave seen in VT following anteroapical infarction<\/span><\/span><\/span><\/p>\n

                      Fascicular VT: RBBB pattern, relatively narrower QRS complex, verapamil sensitive.<\/span><\/span><\/span><\/p>\n

                      Posterior fascicular: left axis deviation; anterior fascicular: right axis deviation; septal fascicular VT: normal axis<\/span><\/span><\/span><\/p>\n

                      Idiopathic Ventricular Tachycardia:<\/strong><\/p>\n

                      Absence of structural heart disease<\/span><\/span><\/span><\/p>\n

                      Symptoms not generally severe<\/span><\/span><\/span><\/p>\n

                      More often in young adults<\/span><\/span><\/span><\/p>\n

                      May be an important cause of tachycardia<\/span><\/span><\/span><\/p>\n

                      Cardiac arrest is rare<\/span><\/span><\/span><\/p>\n

                      VT from RVOT<\/strong> usually occurs in salvoes (Gallavardin). No associated structural heart disease.<\/span><\/span><\/span><\/p>\n

                      It has an LBBB morphology with right axis, exercise induced, catecholamine sensitive and adenosine sensitive due to the mechanism of triggered activity. ARVC also gives rise to VT mimicking idiopathic RVOT VT. <\/span><\/span><\/span><\/p>\n

                      VT in the absence of structural heart disease:<\/strong><\/p>\n

                      RVOT \/ LVOT ventricular tachycardias and ILVT (Idiopathic Left Ventricular Tachycardia)<\/span><\/span><\/span><\/p>\n

                      Channelopathies \u2013 LQTS, Brugada<\/span><\/span><\/span><\/p>\n

                      Therapy in Long QT syndrome:<\/strong><\/p>\n

                      Beta blockers \u2013 highly effective<\/span><\/span><\/span><\/p>\n

                      Pacemakers<\/span><\/span><\/span><\/p>\n

                      ICD: <\/span><\/span><\/span>Rochester ICD-LQTS registry:<\/strong> Interim data presented at HRS 2008:<\/span><\/span><\/span><\/p>\n

                      Females had a higher discharge rate, Those with QT more than 500ms and a history of syncope had higher discharge rate. <\/span><\/span><\/span>LQT2 had the maximum chance of ICD discharge. Dual mutation also conferred higher chance of ICD discharge.<\/span><\/span><\/span><\/p>\n

                      Pacemakers useful in pause dependent torsades or if bradycardia develops due to beta blockers.<\/span><\/span><\/span><\/p>\n

                      Who should get an ICD in Brugada syndrome?<\/strong><\/p>\n

                      Baseline abnormal ECG (without drug challenge), male patient and symptomatic patient have a higher risk. <\/span><\/span><\/span>Inducible tachycardia also carries a higher risk.<\/span><\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

                      Wide QRS tachycardia<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[6],"tags":[1773,1779,2207,2613,3798],"class_list":["post-187","post","type-post","status-publish","format-standard","hentry","category-ecg-electrophysiology","tag-identification-of-vt","tag-idiopathic-ventricular-tachycardia","tag-long-qt-syndrome","tag-nonsustained-vt","tag-sustained-vt"],"yoast_head":"\nWide QRS tachycardia<\/title>\n<meta name=\"description\" content=\"Wide QRS tachycardia\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Wide QRS tachycardia\" \/>\n<meta property=\"og:description\" content=\"Wide QRS tachycardia\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2008-10-03T08:58:31+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2022-08-22T15:26:30+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2008\/10\/wqt1.png\" \/>\n<meta name=\"author\" content=\"Johnson Francis\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Johnson Francis\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"Wide QRS tachycardia\",\"datePublished\":\"2008-10-03T08:58:31+00:00\",\"dateModified\":\"2022-08-22T15:26:30+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/\"},\"wordCount\":381,\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wp-content\\\/uploads\\\/2008\\\/10\\\/wqt1.png\",\"keywords\":[\"Identification of VT\",\"Idiopathic Ventricular Tachycardia\",\"Long QT syndrome\",\"Nonsustained VT\",\"Sustained VT\"],\"articleSection\":[\"ECG \\\/ Electrophysiology\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/\",\"name\":\"Wide QRS tachycardia\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wp-content\\\/uploads\\\/2008\\\/10\\\/wqt1.png\",\"datePublished\":\"2008-10-03T08:58:31+00:00\",\"dateModified\":\"2022-08-22T15:26:30+00:00\",\"description\":\"Wide QRS tachycardia\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/#primaryimage\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wp-content\\\/uploads\\\/2008\\\/10\\\/wqt1.png\",\"contentUrl\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wp-content\\\/uploads\\\/2008\\\/10\\\/wqt1.png\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wide-qrs-tachycardia\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Wide QRS tachycardia\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\",\"name\":\"All About Cardiovascular System and Disorders\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\",\"name\":\"Johnson Francis\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"caption\":\"Johnson Francis\"},\"logo\":{\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\"},\"description\":\"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/author\\\/jf\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Wide QRS tachycardia","description":"Wide QRS tachycardia","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/","og_locale":"en_US","og_type":"article","og_title":"Wide QRS tachycardia","og_description":"Wide QRS tachycardia","og_url":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/","og_site_name":"All About Cardiovascular System and Disorders","article_published_time":"2008-10-03T08:58:31+00:00","article_modified_time":"2022-08-22T15:26:30+00:00","og_image":[{"url":"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2008\/10\/wqt1.png","type":"","width":"","height":""}],"author":"Johnson Francis","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Johnson Francis","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/#article","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/"},"author":{"name":"Johnson Francis","@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"headline":"Wide QRS tachycardia","datePublished":"2008-10-03T08:58:31+00:00","dateModified":"2022-08-22T15:26:30+00:00","mainEntityOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/"},"wordCount":381,"publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/#primaryimage"},"thumbnailUrl":"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2008\/10\/wqt1.png","keywords":["Identification of VT","Idiopathic Ventricular Tachycardia","Long QT syndrome","Nonsustained VT","Sustained VT"],"articleSection":["ECG \/ Electrophysiology"],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/","url":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/","name":"Wide QRS tachycardia","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#website"},"primaryImageOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/#primaryimage"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/#primaryimage"},"thumbnailUrl":"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2008\/10\/wqt1.png","datePublished":"2008-10-03T08:58:31+00:00","dateModified":"2022-08-22T15:26:30+00:00","description":"Wide QRS tachycardia","breadcrumb":{"@id":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/#primaryimage","url":"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2008\/10\/wqt1.png","contentUrl":"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2008\/10\/wqt1.png"},{"@type":"BreadcrumbList","@id":"https:\/\/johnsonfrancis.org\/professional\/wide-qrs-tachycardia\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/johnsonfrancis.org\/professional\/"},{"@type":"ListItem","position":2,"name":"Wide QRS tachycardia"}]},{"@type":"WebSite","@id":"https:\/\/johnsonfrancis.org\/professional\/#website","url":"https:\/\/johnsonfrancis.org\/professional\/","name":"All About Cardiovascular System and Disorders","description":"","publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/johnsonfrancis.org\/professional\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Person","Organization"],"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec","name":"Johnson Francis","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","caption":"Johnson Francis"},"logo":{"@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g"},"description":"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal","url":"https:\/\/johnsonfrancis.org\/professional\/author\/jf\/"}]}},"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/187","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/comments?post=187"}],"version-history":[{"count":1,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/187\/revisions"}],"predecessor-version":[{"id":54659,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/187\/revisions\/54659"}],"wp:attachment":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/media?parent=187"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/categories?post=187"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/tags?post=187"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}