Learning Objectives By LessonWide Complex Tachycardias (WCTs)
- Define wide complex tachycardias (WCTs)
- Create a differential diagnosis for wide complex tachycardias (WCTs)
- Describe the difference between simultaneous and sequential ventricular activation and its general effect on the QRS duration
- Describe the clinical significance of accurate wide complex tachycardia (WCT) differentiation
Implications of Inaccurate WCT Diagnosis
- Describe potential clinical implications of ventricular tachycardia (VT) misdiagnosed as supraventricular tachycardia (SVT)
- Describe potential clinical implications of supraventricular tachycardia (SVT) misdiagnosed as ventricular tachycardia (VT)
AV Dissociation in WCT Differentiation
- Describe AV dissociation and the electrocardiographic features associated with it
- Identify AV dissociation on an ECG
- Describe the utility of AV dissociation in wide complex tachycardia (WCT) differentiation
- Describe the mechanism behind and electrocardiograpghic features associated with capture beats
- Identify capture beats on an ECG
- Describe the mechanism behind and electrocardiograpghic features associated with fusion beats
- Identify fusion beats on an ECG
- Describe how to identify artifact in the context of a wide complex tachycardia (WCT)
QRS Axis in WCT Differentiation
- Describe the utility of QRS axis in differentiation wide complex tachycardias (WCTs)
- Describe and identify QRS axis ECG clues favoring ventricular tachycardia (VT)
QRS Morphology in WCT Differentiation
- Describe the utility of QRS morphology in differentiating wide complex tachycardias (WCTs)
- Describe and identify QRS morphology ECG clues favoring ventricular tachycardia (VT)
- Describe and identify typical left and right bundle branch block ECG features
- Describe and identify atypical left and right bundle branch block ECG features
QRS Duration in WCT Differentiation
- Describe the utility of QRS duration in differentiating wide complex tachycardias (WCTs)
- Describe QRS durations favoring ventricular tachycardia (VT)
Precordial Lead Concordance in WCTs
- Describe the utility of precordial lead concordance in differentiating wide complex tachycardias (WCTs)
- Describe and identify positive and negative precordial lead concordance
Ventricular Activation Velocity in WCTs
- Describe what is meant by ventricular activation velocity in relation to wide complex tachycardias (WCTs)
- Describe the utility of ventricular activation velocity in differentiating wide complex tachycardias (WCTs)
- Describe and identify ventricular activation velocity ECG features favoring ventricular tachycardia (VT)
WCT & Baseline ECG Comparison
- Describe the utility of wide complex tachycardia (WCT) and baseline ECG comparison in differentiating WCTs
- Describe and identify wide complex tachycardia (WCT) and baseline ECG comparison features favoring ventricular tachycardia (VT)
WCT Differentiation Algorithms (Part 1)
- Describe the utility of, and rationale for, coventional multistep algorithms in differentiating wide complex tachycardias (WCTs)
- Describe components of the multistep Brugada algorithm for differentiating wide complex tachycardias (WCTs)
- Apply components of the multistep Brugada algorithm for differentiating wide complex tachycardias (WCTs)
- Describe components of the multistep Vereckei aVR algorithm for differentiating wide complex tachycardias (WCTs)
- Apply components of the multistep Vereckei aVR algorithm for differentiating wide complex tachycardias (WCTs)
- Describe components of the multistep limb lead algorithm for differentiating wide complex tachycardias (WCTs)
- Apply components of the multistep limb lead algorithm for differentiating wide complex tachycardias (WCTs)
- Describe notable limitations of conventional multistep algorithms in differentiating wide complex tachycardias (WCTs)
WCT Differentiation Algorithms (Part 2)
- Describe the utlity of, and rationale for, the Griffith algorithm for differentiating wide complex tachycardias (WCTs)
- Apply the Griffith algorithm for differentiating wide complex tachycardias (WCTs)
- Describe notable advantages and limitations of the Griffith algorithm in differentiating wide complex tachycardias (WCTs)
- Describe the utlity of, and rationale for, the Bayesian algorithm for differentiating wide complex tachycardias (WCTs)
- Apply the Bayesian algorithm for differentiating wide complex tachycardias (WCTs)
- Describe notable advantages and limitations of the Bayesian algorithm in differentiating wide complex tachycardias (WCTs)
- Describe the utlity of, and rationale for, the single-crtierion R-wave-to-peak-time (RWPT) algorithm for differentiating wide complex tachycardias (WCTs)
- Apply the single-crtierion R-wave-to-peak-time (RWPT) algorithm for differentiating wide complex tachycardias (WCTs)
- Describe notable advantages and limitations of the single-crtierion R-wave-to-peak-time (RWPT) algorithm in differentiating wide complex tachycardias (WCTs)
WCT Differentiation Algorithms (Part 3)
- Describe the utlity of, and rationale for, point-based scoring methods for differentiating wide complex tachycardias (WCTs)
- Describe the utlity of, and rationale for, the point-based VT Score algorithm for differentiating wide complex tachycardias (WCTs)
- Apply the point-based VT Score algorithm for differentiating wide complex tachycardias (WCTs)
- Describe the utlity of, and rationale for, the point-based Pachon scoring algorithm for differentiating wide complex tachycardias (WCTs)
- Apply the point-based Pachon scoring algorithm for differentiating wide complex tachycardias (WCTs)
- Describe the utlity of, and rationale for, the point-based Basel algorithm for differentiating wide complex tachycardias (WCTs)
- Apply the point-based Basel algorithm for differentiating wide complex tachycardias (WCTs)
- Describe notable advantages and limitations of the point-based scoring methods in differentiating wide complex tachycardias (WCTs)
ECG Features Favoring Supraventricular Tachycardia with Aberrancy
- Describe ECG feautres favoring supraventricular tachycardia (SVT) with aberrancy over ventricular tachycardia (VT)
- Identify ECG feautres favoring supraventricular tachycardia (SVT) with aberrancy over ventricular tachycardia (VT)
WCT Management
- Describe an approach wide complex tachycardia (WCT) management based on the patient's clinical status
- Identify the appropriate management for an unresponsive patient with a wide complex tachycardia (WCT)
- Identify the appropriate management for an unstable patient with a wide complex tachycardia (WCT)
- Identify the appropriate management for a stable patient in a supraventricular wide complex tachycardia
- Identify the appropriate management for a stable patient in ventricular tachycardia
Contributors: Anthony Kashou, MD; Mahmoud Ismayl, MD; Khalid Saeed Al-Asad, MD; Adnan Halboni, MD; Adolfo Martinez Salazar, MD; Nandan Anavekar, MBBCh
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