14. Tachycardias with Broad Ventricular Complexes

  1. David H. Bennett MD FRCP

Published Online: 1 NOV 2012

DOI: 10.1002/9781118432389.ch14

Bennett's Cardiac Arrhythmias: Practical Notes on Interpretation and Treatment, Eighth Edition

Bennett's Cardiac Arrhythmias: Practical Notes on Interpretation and Treatment, Eighth Edition

How to Cite

Bennett, D. H. (2013) Tachycardias with Broad Ventricular Complexes, in Bennett's Cardiac Arrhythmias: Practical Notes on Interpretation and Treatment, Eighth Edition, John Wiley & Sons, Ltd, Oxford. doi: 10.1002/9781118432389.ch14

Author Information

  1. Senior Consultant Cardiologist, University Hospital of South Manchester, Manchester, UK

Publication History

  1. Published Online: 1 NOV 2012
  2. Published Print: 14 JAN 2013

ISBN Information

Print ISBN: 9780470674932

Online ISBN: 9781118432389

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Keywords:

  • Adenosine;
  • Broad ventricular complexes;
  • Carotid sinus massage;
  • Independent atrial activity;
  • Tachycardias

Summary

Though bundle branch block can sometimes occur during supraventricular tachycardias and therefore lead to broad ventricular complexes, most broad complex tachycardias are ventricular in origin.

Pointers towards ventricular tachycardia as opposed to supraventricular tachycardia with bundle branch block include the presence of myocardial damage, direct or indirect evidence of independent atrial activity, QRS duration greater than 0.14 s, a concordant pattern in the chest leads, and marked axis deviation. Neither minor irregularities during tachycardia nor the haemodynamic effect of the arrhythmia are useful in ascertaining its origin.

When supraventricular tachycardias are associated with bundle branch block the morphology of the ventricular complexes is usually that of typical left or right bundle branch block. Never use verapamil for a diagnostic test. Wherever possible, record a 12-lead ECG during tachycardia for diagnostic purposes.