Abstract
Narrow QRS complex tachycardias or Wide QRS complex tachycardias are common problems encountered in clinical practices. Although such tachycardias often occur in patients with a normal anatomy and/or function of heart and rarely represent life-threatening conditions, they are common sources of morbidity and/or mortality. Narrow QRS complex tachycardias are fast cardiac rhythms with QRS duration of 120 ms or less while wide QRS complex tachycardias are fast cardiac rhythms with QRS duration of 120 ms or more. Origins of narrow QRS complex tachycardias are above or within the His bundle. Wide QRS complex tachycardias can be ventricular tachycardias, supra-ventricular tachycardias with bundle branch block or accessory pathway. The purpose of this chapter is to present the differential diagnosis of narrow and wide QRS complex tachycardias.
Highlights
Differential diagnosis and treatment of tachycardias is a common dilemma encountered by physicians or cardiologists
The NCTs are typically of supraventricular origin above or within the His bundle, rarely narrow complex ventricular tachycardias (VT) have been reported in the literature in which early activation of the His bundle can occur in high septal Ventricular Tachycardia (VT), resulting in relatively narrow QRS complexes of 110–140 ms
Because one flutter wave occurs in the ST-T segment and another flutter wave occurs before each QRS complex in atrial flutter with 2:1 AV conduction, atrial flutter is neither a short RP nor a long RP tachycardia [5, 14–22]
Summary
Differential diagnosis and treatment of tachycardias is a common dilemma encountered by physicians or cardiologists Such tachycardias often occur in patients with a normal heart, they may cause bothersome symptoms and rarely represent life-threatening conditions. SVT; supra-ventricular tachycardia, AVNRT; atrio-ventricular nodal re-entrant tachycardia, AVRT; atrio-ventricular reciprocating tachycardia, AV; atrio-ventricular, VT; ventricular tachycardia, BBB; bundle branch block, AF; atrial fibrillation, VA; ventriculo-atrial. The key to approaching the diagnosis of these arrhythmias is identifying atrial activity (P waves) on the ECG and classifying these tachycardias according to the presence of AV dissociation (Figure 2) and re-classifying according to long RP or short RP (Table 2) [1–5, 14–21]. Digitalis toxicity should be suspected in patients with paroxysmal AT with AV block [5, 14–22]
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