Wide Complex Tachycardia Differentiation: A Reappraisal of the State-of-the-Art

The primary goal of the initial ECG 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...

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Bibliographic Details
Published inJournal of the American Heart Association Vol. 9; no. 11; p. e016598
Main Authors Kashou, Anthony H, Noseworthy, Peter A, DeSimone, Christopher V, Deshmukh, Abhishek J, Asirvatham, Samuel J, May, Adam M
Format Journal Article
LanguageEnglish
Published England John Wiley and Sons Inc 02.06.2020
Wiley
Subjects
Action Potentials
Animals
Diagnosis, Differential
ECG
Electrocardiography
Electrophysiologic Techniques, Cardiac
Heart Conduction System - physiopathology
Heart Rate
Humans
Mini‐Review
Predictive Value of Tests
supraventricular tachycardia
Tachycardia, Supraventricular - diagnosis
Tachycardia, Supraventricular - physiopathology
Tachycardia, Ventricular - diagnosis
Tachycardia, Ventricular - physiopathology
Time Factors
ventricular tachycardia
wide complex tachycardia
ECG
wide complex tachycardia
supraventricular tachycardia
ventricular tachycardia
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Summary:The primary goal of the initial ECG 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 this review, 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.
Bibliography:For Sources of Funding and Disclosures, see page 9.
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.120.016598