Is it VT or Not?

The primary goal of the initial EKG evaluation of every wide complex tachycardia is to determine whether the tachyarrhythmia has a ventricular or supraventricular origin. The answer to this question drives immediate patient care decisions, ensuing clinical workup, and long‐term management strategies. Thus, the importance of arriving at the correct diagnosis cannot be understated and has naturally spurred rigorous research, which has brought forth an ever‐expanding abundance of manually applied and automated methods to differentiate wide complex tachycardias.

In our recent review in the Journal of the American Heart Association, we provide an in‐depth analysis of traditional and more contemporary methods to differentiate ventricular tachycardia and supraventricular wide complex tachycardia. In doing so, we:
1. Review hallmark wide complex tachycardia differentiation criteria,
2. Examine the conceptual and structural design of standard wide complex tachycardia differentiation methods,
3. Discuss practical limitations of manually applied ECG interpretation approaches, and
4. Highlight recently formulated methods designed to differentiate ventricular tachycardia and supraventricular wide complex tachycardia automatically.

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Reference: Kashou AH, Noseworthy PA, DeSimone CV, Deshmukh AJ, Asirvatham SJ, May AM. Wide Complex Tachycardia Differentiation: A Reappraisal of the State-of-the-Art. JAHA. 9;11. 2020.