Wide complex tachycardia: misdiagnosis and outcome after emergent therapy.
The extent and consequence of misdiagnosis of wide complex tachycardia (QRS, 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.
Stewart
R B
RB
Bardy
G H
GH
Greene
H L
HL
D000293:Adolescent; D000328:Adult; D000368:Aged; D003951:Diagnostic Errors; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013610:Tachycardia / Q000175:diagnosis* / Q000188:drug therapy; D014700:Verapamil / Q000009:adverse effects / Q000627:therapeutic use
D014700:Verapamil