Wide Complex Tachycardias: can ECG algorithms safely rule out ventricular tachycardia in the emergency department?

ECG Weekly Workout with Dr. Amal Mattu


A 45-year-old man with PMHx of hypertension, obesity, and tobacco use presents to the ED with palpitations. Symptoms have been intermittent throughout the day with an associated episode of syncope. He is noted to be tachycardic at triage and the following ECG is obtained:

Before watching the video, look closely at this ECG and ask yourself:

  1. What is the heart rate and rhythm?
  2. How can you reliably distinguish ventricular tachycardia from SVT with aberrant conduction using an ECG?
  3. What is the most likely diagnosis?