ECG
Wide complex tachycardia: VT vs SVT
Works through a wide complex tachycardia: haemodynamic instability or an ischaemic presentation means it is treated as VT. The tool then applies the Brugada four-step algorithm with RBBB- and LBBB-like morphology criteria, the Vereckei aVR algorithm and the lead II R-wave peak time, looks for atrial flutter with aberrancy, and lists ESC and ACC/AHA acute management side by side.
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Key rule
A wide complex tachycardia with haemodynamic instability or an ischaemic presentation should be considered VT.
Treat it as VT until proven otherwise — never delay cardioversion to apply an algorithm. The same applies to any WCT in a patient with prior MI or structural heart disease.
Clinical presentation
Rhythm
QRS ≥ 120 ms, rate > 100 bpm
Brugada algorithm
Stepwise: any step positive = VT
4. Morphology criteria
Vereckei aVR algorithm
Lead aVR only; any step positive = VT
Step 4 by measurement (optional)
Lead II R-wave peak time (Pava)
Atrial flutter with aberrancy
Clues to a supraventricular mechanism
Wide complex tachycardia · VT vs SVT
Enter the presentation and work through the ECG criteria. Haemodynamic instability or ischaemia: treat as VT.
References
- Brugada P, et al. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation 1991;83:1649-1659.
- Vereckei A, et al. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm 2008;5:89-98.
- Pava LF, et al. R-wave peak time at DII: a new criterion for differentiating between wide complex QRS tachycardias. Heart Rhythm 2010;7:922-926.
- Brugada J, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. Eur Heart J 2020;41:655-720.
- Zeppenfeld K, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022;43:3997-4126.
- Page RL, et al. 2015 ACC/AHA/HRS Guideline for the management of adult patients with supraventricular tachycardia. Circulation 2016;133:e506-e574.
- Al-Khatib SM, et al. 2017 AHA/ACC/HRS Guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Circulation 2018;138:e272-e391.
- Ortiz M, et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. Eur Heart J 2017;38:1329-1335.