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Wide Complex Tachycardia: Misdiagnosis and Outcome After Emergent Therapy

[+] Article, Author, and Disclosure Information

Grant support: in part by a grant from the American Heart Association, Washington Affiliate; and the Seattle Medic I Emergency Medical Services Foundation.

▸Requests for reprints should be addressed to Gust H. Bardy, M.D.; Division of Cardiology, Harborview Medical Center, 325 Ninth Avenue; Seattle, WA 98104.

Seattle, Washington

© 1986 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1986;104(6):766-771. doi:10.7326/0003-4819-104-6-766
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The extent and consequence of misdiagnosis of wide complex tachycardia (QRS1 120 ms or more; heart rate, 100 or more beats/min) presenting emergently were assessed. Forty-six consecutive episodes of wide complex tachycardia were reviewed and their tachycardia mechanisms subsequently established. All 8 episodes of supraventricular tachycardia with aberrant conduction were correctly diagnosed, whereas 15 of 38 episodes of ventricular tachycardia (39%) were misdiagnosed as supraventricular tachycardia at the time initial therapy was given. Ventriculoatrial dissociation was evident in 11 (73%) of the electrocardiograms of misdiagnosed ventricular tachycardia. Patients with misdiagnosed episodes had poorer outcomes than those with episodes correctly diagnosed (p=0.0003). Verapamil was administered to patients in 13 of the 15 episodes of misdiagnosed ventricular tachycardia; hemodynamic deterioration occurred in all 13 episodes. Wide complex tachycardia is often incorrectly diagnosed as supraventricular tachycardia when, in fact, the 12-lead electrocardiogram strongly suggests ventricular tachycardia. Verapamil is commonly administered in these circumstances and is frequently associated with a poor outcome.





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