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VT vs SVT Differentiation — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyVT vs SVT DifferentiationEECC

A 35-year-old man presents with recurrent palpitations. ECG during an episode shows a wide-complex tachycardia at 200 bpm with an RBBB pattern, left axis deviation, and AV dissociation. What feature most reliably distinguishes VT from SVT with aberrancy?

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Correct answer: E — AV dissociation — the presence of independent P-wave activity during a wide-complex tachycardia is virtually diagnostic of VT

AV dissociation (independent atrial and ventricular activity with the atrial rate slower than the ventricular rate) is the most specific ECG criterion for VT in the context of a wide-complex tachycardia. Other features favouring VT include: fusion beats, capture beats, concordance across precordial leads, very broad QRS (>160 ms), northwest axis, and Brugada/Vereckei algorithm criteria. In clinical practice, any wide-complex tachycardia should be treated as VT until proven otherwise, especially in patients with structural heart disease. The Brugada algorithm and Vereckei algorithm provide stepwise approaches to differentiation. Heart rate alone does not distinguish VT from SVT.

Reference: ESC (2022): Guidelines on Ventricular Arrhythmias and Prevention of Sudden Cardiac Death