Broad complex tachycardia

Definition

• Heart rate > 100 beats per minute
• QRS duration > 0.12 sec ( 3 small squares )

If the patient is unstable, or you are feeling uncertain, do not over-complicate your management. Follow the management broad complex tachycardia Resusc Council UK algorithm. Call for expert help.

Differential Dx

Ff you are more experienced, and circumstances permit, it is possible to make an attempt to diagnose the rhythm more accurately. This may facilitate focussed treatment. It will require knowledge and understanding of the differential diagnosis.

Differential Dx of broad complex tachycardia:

• Ventricular tachycardia
  • Monomorphic VT
  • Polymorphic VT
  • Torsade de Pointes
  • Special cases e.g. idiopathic tachycardias and RVOT
• SVT with with aberrancy
• SVT with pre-existing BBB
• Atrial or AV-nodal re-entry tachycardia with pre-excitation (rare)
• Much more commonly in EM, If QRS >200ms or rate is <120, think †K⁺ or drug overdose and consider Ca⁺⁺ ± bicarb

Broad complex tachycardia and instability

• Chest pain or shortness of breath
• Evidence of poor peripheral perfusion
• Systolic blood pressure less than 90 mmHg 
• Pulmonary congestion
• Altered level of consciousness

The following are adverse

• Heart rate greater than 150 beats per minute
• Polymorphic VT
• Irregular broad complex tachycardia (?AF with alternative pathway)
• QRS >200ms (one big square) or rate <120 - ? drugs or hyperkalaemia

Management Algorithm

Links

• VT
• Differentiate VT from SVT with abnormal conduction
• Antiarrhythmics in broad complex tachycardia
• Torsade de Pointes