Wide Complex Tachycardias: does response to Valsalva maneuvers or adenosine rule out ventricular tachycardia?

ECG Weekly Workout with Dr. Amal Mattu

HPI

A 54-year-old man with no significant PMHx presents to the ED with palpitations. He is hemodynamically stable with a normal blood pressure. The following ECG is obtained prior to the patient receiving adenosine which successfully converts the rhythm:

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

    1. What is the heart rate and rhythm?
    2. Does response to adenosine or Valsalva maneuvers help rule out ventricular tachycardia?
    3. What is the most likely diagnosis and how would you disposition this patient after conversion to normal sinus rhythm?