[Management of wide QRS complex tachycardia : From acute treatment to long-term prevention]

Wide QRS complex tachycardia is among the most common and clinically relevant arrhythmia emergencies. Its differential diagnosis is often perceived as challenging but can be reduced to a single pathophysiological principle.

This review presents a structured concept for the diagnosis and management of wide QRS complex tachycardia, from the acute setting to long-term recurrence prevention.

The QRS complex is wide only when conduction does not proceed through the His-Purkinje system, yielding three scenarios: ventricular tachycardia, supraventricular tachycardia with aberrancy, and pre-excited tachycardia. Acute management depends on hemodynamic stability; long-term prevention comprises pharmacotherapy, device therapy, and catheter ablation.

Wide QRS complex tachycardia differential diagnosis is less complex than commonly perceived when the underlying principle is understood. Novel ablation techniques expand options in selected cases.