Does this Wide complex tachycardia represents Ventricular Tachycardia or Supraventricular Tachycardia with abberancy?
- The QRS axis is normal – this could be VT or SVT
- The QRS is wide, over 0.14s
- The QRS complexes are upright in all the precordial leads (positive concordant pattern) – this favors VT
- The morphology is not typical for RBBB – this would support VT
- Absence of an RS pattern strongly favors VT
- The most compelling point is provided in the ladder diagram bellow. There are retrograde P waves following every other QRS complex. This represents ventriculo-atrial conduction (VA association) and makes VT a virtual certainty.
So the diagnosis is Ventricular Tachycardia.