This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (25)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Ventricular Tachycardia Is the Most Frequent Cause

Russell T. Steinman, MD; Cesar Herrera, MD; Claudio D. Schuger, MD; Michael H. Lehmann, MD

JAMA. 1989;261(7):1013-1016.

Abstract
Hemodynamic stability during wide QRS tachycardia is commonly, albeit erroneously, taken as evidence for a supraventricular mechanism. To determine the magnitude for potential misdiagnosis in applying this notion clinically, we analyzed 20 consecutive cases of regular wide QRS tachycardia in conscious adult patients (mean age, 64 years). The most common heart disease was atherosclerotic (75%), with an associated history of remote myocardial infarction in 73% of the cases. Tachycardia was sustained for a mean of 4.8 hours prior to medical evaluation, with a mean rate of 186 beats per minute and mean systolic blood pressure of 111 mm Hg. A diagnosis of ventricular tachycardia (VT) was established in 17 cases (85%). In the patients with VT, atrioventricular dissociation was recognized on the 12-lead electrocardiogram in 38%, with Wellens' morphological features favoring the diagnosis in 73%. Following conversion to sinus rhythm, electrophysiological testing in 17 patients reproduced the clinical arrhythmia in 94% (with a replication rate of 100% in 15 patients with VT), with at least one additional unsuspected VT morphology induced in 53% of patients with VT. Thus, VT should be considered the most likely cause of regular wide QRS tachycardia in the conscious adult patient, especially with a history of remote myocardial infarction. Recognition of this simple principle and careful examination of the 12-lead electrocardiogram may help to prevent the misapplication of pharmacotherapy in the vast majority of these patients.

(JAMA 1989;261:1013-1016)

Author Affiliations
From the Electrophysiology Laboratory and Arrhythmia Service, Division of Cardiology, Harper Hospital, and the Department of Internal Medicine, Wayne State University, Detroit.

Footnotes
Reprint requests to Division of Cardiology, Harper Hospital, 3990 John R St, Detroit, MI 48201 (Dr Steinman).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Life-Threatening Arrhythmias in the Intensive Care Unit
Reising et al.
J Intensive Care Med 2007;22:3-13.
ABSTRACT  

Fascicular tachycardia: uncommon or just unrecognised?
Eynon et al.
Emerg. Med. J. 2002;19:477-478.
FULL TEXT  

Case 20-2000- A 61-Year-Old Man with a Wide-Complex Tachycardia
Stevenson and Aretz
NEJM 2000;342:1979-1987.
FULL TEXT  

WIDE QRS TACHYCARDIA IN CONSCIOUS ADULTS IS OFTEN VENTRICULAR
JWatch General 1989;1989:4-4.
FULL TEXT