Wide-complex tachycardia that didn ’t follow the rules

ConclusionIt is well worth remembering that this was a rare case! In most middle-aged patients with a history of cardiomyopathy, a WCT will usually be VT. Furthermore, while specific criteria (e.g. precordial RS duration, aVR morphology) may not be perfectly sensitive, the are more likely to be helpful than suspecting 1:1 atrial flutter in patients not taking sodium-channel-blocking antiarrhythmics.Comparison of the old and WCT ECGsmight have suggested an SVT or atrial flutter at the time of presentation. However, it would not have been prudent for most clinicians to try e.g. a calcium-channel blocker as the first agent. When not absolutely sure, treat as VT!Adenosine is safe in VT and may be useful in making the diagnosis.
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs