A patient presenting at the emergency department with symptoms of palpitations

Summary

An accurate interpretation of a 12 lead ECG recorded within 10 minutes after admission is essential in managing patients presenting at the emergency department with symptoms of palpitations caused by a paroxysmal tachycardia. When the ECG shows a regular broad QRS tachycardia, it is crucial to differentiate a ventricular tachycardia from supraventricular tachycardia with a pre-existent conduction disorder or aberrant conduction or an antidromic AV reentry tachycardia using an accessory atrioventricular pathway.  In this ECG challenge, we discuss a patient presenting with broad QRS tachycardia and the ECG criteria for the diagnosis of ventricular tachycardia.