Broad Complex Tachycardia

Key points

• Features suggesting VT rather than SVT with aberrant conduction: AV dissociation · fusion or capture beats · positive QRS concordance in chest leads · marked left axis deviation · history of IHD · lack of response to adenosine or carotid sinus massage · QRS >160 ms.
• AV dissociation is the key single discriminator of VT over SVT with aberrancy.
• A broad complex tachycardia in a patient with IHD should be managed as VT — and verapamil must not be given.

Decision points in this pathway

• Any features suggesting VT: AV dissociation · fusion or capture beats · positive QRS concordance in chest leads · marked left axis deviation · history of IHD · lack of response to adenosine or carotid sinus massage · QRS >160 ms?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.