Wide QRS complex tachycardia: differential diagnosis and emergency therapy

Main Article Content

G. M. Solovyan
T. V. Mikhalieva


The lecture is devoted to a serious problem in clinical practice – diagnosis and treatment of wide QRS complex tachycardia, requiring an individual approach. The main principles of the detection of different types of wide QRS complex tachycardia and their electrophysiological mechanisms are considered. The article deals with etiology of wide QRS complex tachycardia, as well as clinical and electrocardiographic criteria for differential diagnosis between ventricular tachycardia and supraventricular tachycardia with aberrant conduction. Key aspects of wide QRS complex tachycardia are discussed, and the ECG examples of certain forms of wide QRS complex tachycardia are presented. The principles of emergency care and long-term therapy for narrow and wide QRS complex tachycardia are considered. Information regarding antiarrhythmic drugs usage and general principles of catheter treatment of tachycardia is provided.

Article Details


Wide QRS complex tachycardia: differential diagnosis and emergency therapy


Ardashev VN, Ardashev VA, Steklov VІ. Treatment of heart rhythm disturbances. M.: ID MEDPRAKTIKA, 2005. 228 p. (in Russ.). https://www.books-up.ru/ru/excerpt/lechenie-narushenij-serdechnogo-ritma-2354103/?page=1

Zharinov OY, Kuts VO, Hrytsai OM, Vieriezhnikova GP. Supraventricular tachycardia [Electronic resource]. Medytsyna svitu [Medicine of the world] 2013. Rezhym dostupu: http://msvitu.com/archive/2013/september/article-1.php?print=1. – Nazva z ekranu. (in Ukr.).

Zadionchenko VS, Shekhian GG, Shchikota AM, Ialymov AA. Differential diagnosis of wide tachycardia. RMZh: Nezavisimoe izdanie dlia praktikuiushchikh vrachei [Russian Medical Journal:Independent publication for practicing doctors] 2012;14:734–740 (in Russ.). https://www.rmj.ru/articles/kardiologiya/Differencialynaya_diagnostika_shirokih_tahikardiy/

Kushakovskii MS, Grishkin YN. Heart arrhythmias. Cardiac rhythm disorders and conduction impairment. Manual for doctors . SPb.: “Foliant”, 2014.720 p. (in Russ). https://www.books-up.ru/en/book/aritmii-serdca-rasstrojstva-serdechnogo-ritma-i-narusheniya-provodimosti-prichiny-mehanizmy-elektrokardiograficheskaya-i-elektrofiziologicheskaya-diagnostika-klinika-lechenie-5745869/

Kovalenko VN, Sychev OS. Heart rhythm and conduction disorders. A guide for doctors. Kiev, 2009.654 p. (in Ukr.).

Nedostup AV. Some difficulties and controversial issues of arrhythmia. Kardiologiia i serdechno-sosudistaia khirurgiia [Cardiology and cardiovascular surgery] 2007;1:90–15 ( in Russ.). http://www.fesmu.ru/elib/Article.aspx?id=170571

Rozendorff K. Fundamentals of Cardiology: Principles and Practices (2nd edition). Lvov: Meditcina svіtu, 2007.1064p. (in Ukr.) http://kingmed.info/knigi/Kardiologiya/book_2605/Osnovi_kardiologii_Printsipi_i_praktika_2-e_izdanie-Rozendorff_K-2005-pdf

Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Arytmolohiia [Arytmology] 2016;2(18):5–36. doi: http://doi.org/10.1093/eurheartj/ehv316. (in Ukr.)

Chazov EI, Golitcyn SP . Guide to heart rhythm disturbances. M.: GEOTAR-Media, 2010. 416 p. (in Russ.). http://www.geotar.ru/lots/Q0008430.html

2006 ACC/AHA/ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Circulation 2006;114:e385–484.

Allessie MA. Atrial re-entry / Allessie M.A., Bonke f.I., Kirhhof C.J. Cardiac Electrophysiology. Textbook / M. Rosen, M. Janse, A. Wit [eds.] – Mount Kisco, NY: Futura Publishing Compani INC, 1990.555–571pp. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1024663/

Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. J Am Coll Cardiol 1992;20:1391–1396. https://www.ncbi.nlm.nih.gov/pubmed/1309182

Brugada R, Brugada J, Antzelevitch C, Kirsch G, Potenza D, Towbin J, Brugada P. Sodium channel blockers identify risk for sudden death in patients with ST-segment elevation and right bundle branch block but structurally normal hearts. Circulation 2000;101:510–515. https://www.ncbi.nlm.nih.gov/pubmed/10662748

Caceres J, Jazayeri M, McKinnie J, Avitall B, Denker S, Tchou P, Akhtar M. Sustained bundle branch reentry as a mechanism of clinical tachycardia. Circulation 1989;79:256–270. https://www.ncbi.nlm.nih.gov/pubmed/2914345

Issa Z, Miller J, Zipes D. Clinical Arrhythmology and Electrophysiology: A comparison to Braunwaldʼs Heart Disease. Saunders,2012.744p. https://www.elsevier.com/books/clinical-arrhythmology-and-electrophysiology-a-companion-to-braunwalds-heart-disease/issa/978-1-4160-5998-1

Laitinen P, Swan H, Kontula K. Molecular genetics of exercise-induced polymorphic ventricular tachycardia: identification of three novel cardiac ryanodine receptor mutations and two common calsequestrin 2 amino-acid polymorphisms. Eur J Hum Genet 2003;11:888–891. http://doi.org/10.1038/sj.ejhg.5201061

Lerman B. Response of nonreentrant catecholamine-mediated ventricular tachycardia to endogenous adenosine and acetylcholine. Evidence for myocardial receptor-mediated effects. Circulation 1993;87:382–390.

Lim S, Anantharaman V, Teo W, Chan Y. Slow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia. Resuscitation 2009;80:523–528. http://doi.org/10.1016/j.resuscitation.2009.01.017

Mandel W, Podrid PJ, Kowey PR. Sustained monomorphic ventricular tachycardia. Cardiac arrhythmia. Mechanisms, diagnosis and management Baltimore: Williams&Wilkins, 1995.919–935. https://www.uptodate.com/contents/sustained-monomorphic-ventricular-tachycardia-in-patients-with-structural-heart-disease-treatment-and-prognosis

Markowitz S, Stein K, Mittal S, Slotwiner D, Lerman B. Differential effects of adenosine on focal and macroreentrant atrial tachycardia. J Cardiovasc Electrophysiol 1999;10:489–502. https://www.ncbi.nlm.nih.gov/pubmed/10355690

Podrid P. Cardiac Arrhythmia: Mechanisms, Diagnosis, and Management / P. Podrid, P. Kowey. – LWW, 2001. 973 p. https://www.internationaljournalofcardiology.com/article/0167-5273(96)02614-9/abstract

Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NA, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM; Evidence Review Committee Chair. 2015 ACC/AHA/HRS Guidelines for the Management of Adult Patients With Supraventricular Tachycardia. J Am Coll Cardiol 2016;67:e27–115. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000311

Priori S, Napolitano S. Role of genetic analyses in cardiology. Part I: Mendelian diseases: cardiac channelopathies. Circulation 2006;113:1130–1135. http://doi.org/10.1161/CIRCULATIONAHA.105.563205

Schwarts P, Moss A, Vincent G, Crampton R. Diagnostic criteria for the long QT syndrome. Circulation 1993;88:782–784. http://doi.org/10.1161/01.cir.88.2.782

Schwarts PJ, Priori SG, Spazzolini C, Moss A, Vincent G, Napolitano C, Denjoy I, Guicheney P, Breithardt G, Keating M, Towbin J, Beggs A, Brink P, Wilde A, Toivonen L, Zareba W, Robinson J, Timothy K, Corfield V, Wattanasirichaigoon D, Corbett C, Haverkamp W, Schulze-Bahr E, Lehmann M, Schwartz K, Coumel P, Bloise R. Genotypephenotype correlation in the long – QT syndrome: Genespecific triggers for the life – threatening arrhythmias. Circulation 2001;103:89–95. https://www.ncbi.nlm.nih.gov/pubmed/11136691

Spector P, Reinolds MR, Calkins H, Sondhi M, Xu Y, Martin A, Williams C, Sledge I. Meta-analysis of ablation of atrial flutter and supraventricular tachycardia. Am J Cardiol 2009;104:671–677. http://doi.org/10.1016/j.amjcard.2009.04.040

Tubaro M, Vranckx P, Price S, Vrints C. The ESC Textbook of Intensive and Acute Cardiovascular Care (The European Society of Cardiology). Oxford University Press,2015.882 p. http://oxfordmedicine.com/view/10.1093/med/9780199687039.001.0001/med-9780199687039

Wanless R, Anderson K, Joy M, Joseph S. Multicenter comparative study of the efficacy and safety of sotalol in the prophylactic treatment of patients with paroxysmal supraventricular tachyarrhythmias. Am Heart J 1997; 133: 441-446. https://www.ncbi.nlm.nih.gov/pubmed/9124166