Rhythm diagnosis in regular wide complex tachycardia - Revision history

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2026-03-22T09:24:23Z

Strip excess bold text

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	==Diagnostic Algorithms==		==Diagnostic Algorithms==
	~~'''~~Assume [[ventricular tachycardia]] until proven otherwise~~'''~~		Assume [[ventricular tachycardia]] until proven otherwise
	*Only for regular rhythms, if irregular consider a-fib with block		*Only for regular rhythms, if irregular consider a-fib with block
	*Only for treatment decision if patient is stable		*Only for treatment decision if patient is stable
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	[[File:Wide Complex Tachycardia.png\|thumb\|Neimann Algorithm for Regular WCT]]		[[File:Wide Complex Tachycardia.png\|thumb\|Neimann Algorithm for Regular WCT]]
	*Combination of the most specific aspects of the above two algorithms		*Combination of the most specific aspects of the above two algorithms
	Acronym: <big>CARMA</big> → ~~'''~~Concordance → aVR →Regular → Morphology →AV dissociation~~'''~~		Acronym: <big>CARMA</big> → Concordance → aVR →Regular → Morphology →AV dissociation

	*Presence of an initial ~~'''~~R wave in aVR~~'''~~? <ref>Vereckei A et al. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachy- cardia. Heart Rhythm 2008; 5:89-98</ref><ref>Szelenyi Z, et al. Acad Emerg Med 2013;20:1121- 1130</ref>		*Presence of an initial R wave in aVR? <ref>Vereckei A et al. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachy- cardia. Heart Rhythm 2008; 5:89-98</ref><ref>Szelenyi Z, et al. Acad Emerg Med 2013;20:1121- 1130</ref>
	**If yes then VT		**If yes then VT
	**If no then continue		**If no then continue
	*Is there ~~'''~~concordance~~'''~~ (monophasic with same polarity) in all of the precordial leads? <ref>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</ref>		*Is there concordance (monophasic with same polarity) in all of the precordial leads? <ref>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</ref>
	**If yes then VT [[File:concord.jpg\|thumb\|Example of concordance in precordial leads]] [[File:disconcord.jpg\|thumb\|Example of disconcordance in precordial leads]]		**If yes then VT [[File:concord.jpg\|thumb\|Example of concordance in precordial leads]] [[File:disconcord.jpg\|thumb\|Example of disconcordance in precordial leads]]
	**If no then continue		**If no then continue
	*Is there evidence of ~~'''~~AV dissociation/Capture beats~~'''~~? [[File:capture.jpg\|thumb\|Example of capture beat]]		*Is there evidence of AV dissociation/Capture beats? [[File:capture.jpg\|thumb\|Example of capture beat]]
	**If yes then VT		**If yes then VT
	**If no then continue		**If no then continue
	*Is the QRS ~~'''~~morphology~~'''~~ in V1 and V6 consistent with either ~~'''~~[http://wikem.org/wiki/Left_bundle_branch_block LBBB]~~'''~~ or ~~'''~~[http://wikem.org/wiki/Right_bundle_branch_block RBBB]~~'''~~? <ref>Brugada, Circulation; Griffith MJ et al. Lancet 1994;343:386-388</ref><ref>Wellens HJJ et al. Am J Med 1978; 64:27-33</ref>		*Is the QRS morphology in V1 and V6 consistent with either [http://wikem.org/wiki/Left_bundle_branch_block LBBB] or [http://wikem.org/wiki/Right_bundle_branch_block RBBB]? <ref>Brugada, Circulation; Griffith MJ et al. Lancet 1994;343:386-388</ref><ref>Wellens HJJ et al. Am J Med 1978; 64:27-33</ref>
	**If no then VT		**If no then VT
	**If yes then SVT with aberrancy		**If yes then SVT with aberrancy

Rossdonaldson1: /* Diagnostic Algorithms */

2020-08-12T18:09:50Z

Diagnostic Algorithms

← Older revision		Revision as of 18:09, 12 August 2020
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	*Only for regular rhythms, if irregular consider a-fib with block		*Only for regular rhythms, if irregular consider a-fib with block
	*Only for treatment decision if patient is stable		*Only for treatment decision if patient is stable


	===Brugada Algorithm===		===Brugada Algorithm===

	*Absence of an RS complex in all precordial leads?		*Absence of an RS complex in all precordial leads?
	**If yes then VT		**If yes then VT
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	===aVR Algorithm===		===aVR Algorithm===

	*In lead aVR:		*In lead aVR:

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	===Niemann Algorithm<ref>James Niemann MD FACEP is EM Faculty at Harbor-UCLA Medical Center and prominent resuscitation researcher</ref>===		===Niemann Algorithm<ref>James Niemann MD FACEP is EM Faculty at Harbor-UCLA Medical Center and prominent resuscitation researcher</ref>===

	[[File:Wide Complex Tachycardia.png\|thumb\|Neimann Algorithm for Regular WCT]]		[[File:Wide Complex Tachycardia.png\|thumb\|Neimann Algorithm for Regular WCT]]

	*Combination of the most specific aspects of the above two algorithms		*Combination of the most specific aspects of the above two algorithms
	Acronym: <big>CARMA</big> → '''Concordance → aVR →Regular → Morphology →AV dissociation'''		Acronym: <big>CARMA</big> → '''Concordance → aVR →Regular → Morphology →AV dissociation'''

Rossdonaldson1: /* Diagnostic Algorithms */

2019-04-05T07:05:53Z

Diagnostic Algorithms

← Older revision		Revision as of 07:05, 5 April 2019
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	==Diagnostic Algorithms==		==Diagnostic Algorithms==
			'''Assume [[ventricular tachycardia]] until proven otherwise'''
	*Only for regular rhythms, if irregular consider a-fib with block		*Only for regular rhythms, if irregular consider a-fib with block
	*Only for treatment decision if patient is stable		*Only for treatment decision if patient is stable
	*Assume V-tach until proven otherwise

	===Brugada Algorithm===		===Brugada Algorithm===

Rossdonaldson1: /* Evaluation */

2019-04-05T07:04:52Z

Evaluation

← Older revision		Revision as of 07:04, 5 April 2019
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	*Some patients with '''regular''' [[wide complex tachycardia]] do not have [[ventricular tachycardia]]		*Some patients with '''regular''' [[wide complex tachycardia]] do not have [[ventricular tachycardia]]
	*However, [[ventricular tachycardia]] is a dangerous rhythm that must be treated emergently		*However, [[ventricular tachycardia]] is a dangerous rhythm that must be treated emergently

			==Differential Diagnosis==
			{{Tachycardia (wide) DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* See Also */

2019-04-05T06:02:58Z

Tomfadial: /* Niemann AlgorithmJames Niemann MD FACEP is EM Faculty at Harbor-UCLA Medical Center and prominent resuscitation researcher */

2018-07-05T13:38:12Z

Niemann AlgorithmJames Niemann MD FACEP is EM Faculty at Harbor-UCLA Medical Center and prominent resuscitation researcher

← Older revision		Revision as of 13:38, 5 July 2018
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	===Niemann Algorithm<ref>James Niemann MD FACEP is EM Faculty at Harbor-UCLA Medical Center and prominent resuscitation researcher</ref>===		===Niemann Algorithm<ref>James Niemann MD FACEP is EM Faculty at Harbor-UCLA Medical Center and prominent resuscitation researcher</ref>===

	[[File:Wide Complex Tachycardia.png\|thumb]]		[[File:Wide Complex Tachycardia.png\|thumb\|Neimann Algorithm for Regular WCT]]

	*Combination of the most specific aspects of the above two algorithms		*Combination of the most specific aspects of the above two algorithms

Tomfadial: /* Niemann AlgorithmJames Niemann MD FACEP is EM Faculty at Harbor-UCLA Medical Center and prominent resuscitation researcher */

2018-07-05T13:37:42Z

Niemann AlgorithmJames Niemann MD FACEP is EM Faculty at Harbor-UCLA Medical Center and prominent resuscitation researcher

← Older revision		Revision as of 13:37, 5 July 2018
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	===Niemann Algorithm<ref>James Niemann MD FACEP is EM Faculty at Harbor-UCLA Medical Center and prominent resuscitation researcher</ref>===		===Niemann Algorithm<ref>James Niemann MD FACEP is EM Faculty at Harbor-UCLA Medical Center and prominent resuscitation researcher</ref>===

			[[File:Wide Complex Tachycardia.png\|thumb]]

	*Combination of the most specific aspects of the above two algorithms		*Combination of the most specific aspects of the above two algorithms

Rossdonaldson1: Rossdonaldson1 moved page Differentiating ventricular vs. paroxysmal supraventricular tachycardia to Rhythm diagnosis in regular wide complex tachycardia

2018-03-14T12:07:51Z

Rossdonaldson1 moved page Differentiating ventricular vs. paroxysmal supraventricular tachycardia to Rhythm diagnosis in regular wide complex tachycardia

← Older revision	Revision as of 12:07, 14 March 2018
(No difference)

Rossdonaldson1: /* Background */

2018-03-14T12:06:08Z

Background

← Older revision		Revision as of 12:06, 14 March 2018
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	==Background==		==Background==
	*Some patients with '''regular''' [[wide complex tachycardia]] do not have [[ventricular tachycardia]]		*Some patients with '''regular''' [[wide complex tachycardia]] do not have [[ventricular tachycardia]]
	*However, ventricular tachycardia is a dangerous rhythm that must be treated emergently		*However, [[ventricular tachycardia]] is a dangerous rhythm that must be treated emergently

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Background */

2018-03-14T12:05:39Z

Background

← Older revision		Revision as of 12:05, 14 March 2018
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	==Background==		==Background==
	*Some patients with [[wide complex tachycardia]] do not have [[ventricular tachycardia]]		*Some patients with '''regular''' [[wide complex tachycardia]] do not have [[ventricular tachycardia]]
	*However, ventricular tachycardia is a dangerous rhythm that must be treated emergently		*However, ventricular tachycardia is a dangerous rhythm that must be treated emergently
	*Ventricular tachycardia vs. supraventricular tachycardia

	==Evaluation==		==Evaluation==

← Older revision		Revision as of 06:02, 5 April 2019
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	==See Also==		==See Also==
	*[[~~Tachycardia (~~Wide)]]		*[[Wide-complex tachycardia]]
	*[[SVT]]		*[[SVT]]
	*[[ACLS (Main)]]
	*[[ACLS: Tachycardia]]		*[[ACLS: Tachycardia]]
	*[[PALS (Main)]]
	*[[PALS: Tachycardia]]		*[[PALS: Tachycardia]]