Among patients with wide-complex tachycardia, what are the clues to help distinguish between ventricular tachycardia (VT) versus supraventricular tachycardia (SVT) with aberrancy?
Clinical clues:
| Presenting symptoms | Not Helpful |
| History of CAD and previous MI | VT |
Physical Exam:
|
|
| Carotid sinus massage/adenosine terminate arrhythmia | SVT* |
| AV dissociation | VT |
| Capture or fusion | VT |
| QRS width>140 msec | VT |
| Extreme axis deviation (left or right superior axis) |
VT |
| Positive QRS concordance (R wave across chest leads) |
VT |
| Negative QRS concordance (S wave across chest leads) |
may suggest VT |
| Axis shift during arrhythmia | VT (polymorphic) |
*if patient >65 and previous MI or structural heart disease, then chance of VT is >95%.
