Wide complex SVT versus VT

Specialties CCU

Published

Is there any tips on fast recognition of wide complex SVT versus VT? When there is just a few beats of this arrythmia I feel this is difficult to distinguish at times.

Specializes in CTICU.

Actually no, someone said if adenosine does not work it "may be ventricular".

I do not think the original poster was asking about ACLS algorithms or treatments, but how to diagnose WCT on ECG.

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Specializes in CCRN-CMC-CSC: CTICU, MICU, SICU, TRAUMA.

Use The Netherlands Clues (named so from research originating in The Netherlands by Brugada and colleagues). Any of the following = VT: No RS in any precordial lead, R to S interval > 100 ms in any precordial lead, AV dissociation, Morphology criteria for VT present in V1-2 and V6.

In a wide QRS tachycardia, if no precordial lead displays an RS complex, or if any precordial lead displays an RS complex that measures greater than 100 milliseconds from onset to nadir, ventricular tachycardia (VT) is the favored diagnosis. Atrioventricular dissociation and the morphology clues favoring VT in V1-2 and V6 are also helpful.

The San Francisco Clue in either RBBB or LBBB morphologies is as such (based on research done by Drew and Scheinman in San Francisco): In wide QRS tachycardias of either right or left bundle-branch block morphology, if measurement from beginning of QRS to tallest peak or to nadir of S wave is less than 50 milliseconds in V6 or MCL6, aberration is favored. If the measurement is more than 70 ms, VT is favored.

Is anyone familiar with these tidbits?

You can find them in Cardiac Nursing, 4th Ed. by Woods, Froelicher and Motzer published by Lippincott

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As a side note to the poster who states "no 12 lead, no axis deviation".

Almost every monitor Defibrillator that I have used in the past 19 years, dating back to the old trusty LP 5, has the ability to switch into "diagnostic mode". That combines with using MCL placements will enable you to acquire your precordial leads.

YOU just have to read the users manual for your machine, it should be buried in there somewhere.

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

Yes, NoviceToExpert, our Cardiologists teach/use Brugada's criteria to sort these rhythms out.

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