Cardiac Arrhythmias - Part II: Broad Complex Tachycardia

The acute management of the patient presenting with a broad complex tachycardia is a daunting clinical challenge. A broad complex tachycardia may be ventricular or supraventricular in origin and the ability to interpret correctly the 12-lead electrocardiogram is of critical importance in this differentiation. Broad complex tachycardia should be assumed to be ventricular in origin unless there is compelling clinical and electrocardiographic evidence to the contrary. This article focuses on the immediate diagnosis and management of broad complex tachycardia. In view of the broadening indications for implantation of cardioverterdefibrillator devices (ICD) in the management of ventricular arrhythmias, an approach to the ICD patient presenting to the accident and emergency department with recurrent device discharges is discussed.