From the Guidelines
The primary cause of wide complex tachycardia requiring immediate medical attention is ventricular tachycardia (VT), which originates from the heart's ventricles. This life-threatening arrhythmia demands urgent intervention as it can rapidly deteriorate into ventricular fibrillation and cardiac arrest. According to the 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1, patients presenting with sustained VT should be treated according to symptoms and tolerance of the arrhythmia.
Key Considerations
- Patients presenting with monomorphic VT and haemodynamic instability should undergo direct cardioversion 1.
- In patients who are hypotensive and yet conscious, immediate sedation should be given before undergoing cardioversion 1.
- For patients with wide complex tachycardia who are haemodynamically stable, electrical cardioversion should be the first-line approach 1.
- Intravenous procainamide or flecainide may be considered for those who do not present with severe HF or acute myocardial infarction, while intravenous amiodarone may be considered in patients with HF or suspected ischemia 1.
Management Approach
- Initial management includes assessing hemodynamic stability and administering appropriate medications.
- For unstable patients with compromised blood pressure or consciousness, immediate synchronized cardioversion at 100-200 joules is indicated.
- In stable patients, intravenous antiarrhythmic medications like amiodarone or procainamide may be used.
- While other conditions like supraventricular tachycardia with aberrant conduction can present similarly, ventricular tachycardia is most concerning due to its association with underlying structural heart disease, electrolyte abnormalities, or medication toxicity, as noted in the 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations 1.
Prioritizing Patient Outcomes
- Prompt recognition and treatment are essential as sustained ventricular tachycardia significantly increases the risk of sudden cardiac death.
- The choice of treatment depends on the stability of the patient and the rhythm, with electric cardioversion being the preferred option for hemodynamically unstable patients 1.
From the Research
Causes of Wide Complex Tachycardia
The primary cause of wide complex tachycardia that requires immediate medical attention is ventricular tachycardia (VT) [ 2, 3 ].
Key Factors
- VT is a potentially fatal cardiac rhythm disorder [ 4 ]
- It is associated with a high mortality rate [ 3 ]
- Recurrent episodes of VT in patients with structural heart disease are associated with increased mortality and morbidity [ 5 ]
Types of Wide Complex Tachycardia
- Monomorphic ventricular tachycardia [ 6 ]
- Polymorphic ventricular tachycardia
- Torsades de pointes