1. Differential diagnosis in narrow QRS complex tachycardias
Hosted by DR Adrian Baranchuk MD FACC and DR Kevin Michael MBCB MPhil MD
Presentation

2. “There is no algorithm that can cover ALL clinical scenarios”…
Overview
A simple and useful algorithm to differentiate narrow complex tachycardias
Clinical applicability
Easy to remember
Real clinical cases
Some less frequent presentations
“There is no algorithm that can cover ALL clinical scenarios”…
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

3. Algorithm 3 Questions: Narrow vs. Wide Regular vs. Irregular
Where is the P-Wave
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

4. Wide Complex Tachycardia
Tachycardias
SUPRAVENTRICULAR
VENTRICULAR
SINUS TACHYCARDIA
ATRIAL FIBRILLATION
ATRIAL FLUTTER
ATRIAL TACHYCARDIA
AVNRT
AVRT
MONOMORPHIC VT
POLYMORPHIC VT
TORSADES DES POINTES
VENTRICULAR FIBRILLATION
90%
Narrow Complex Tachycardia
Wide Complex Tachycardia
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

5. Algorithm Narrow Complex Tachycardia
Regular
P before QRS
Atrial Fibrillation
A. Flutter w/variab.con.
No P waves
- P after QRS + - ST
LAT
AVNRT JT
Saw tooth
A Flutter
RP<PR
RP>PR
AVRT
Atypical AVNRT
Irregular
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

6. Cardiac Tamponade CASE 1 Sinus tachycardia Electrical alternans
Low qrs voltage
Cardiac Tamponade
CASE 1
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

7. Low Atrial Tachycardia
- P-wave inf. Leads
- P-wave in lead I
Activation caudo-cranial left to right
Negative P-waves
in inferior leads
CASE 2
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

8. Atrial Flutter CASE 3 Saw tooth Think in AFL if HR 150 bpm @ rest!!!
CSM: variable conduction
Atrial Flutter
CASE 3
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Workshop

9. Sinus Tachycardia CASE 4 VAGAL MANEUVERS SVT: “all or none”
A Flutter: ↑ degree of block
Sinus Tach: slow the rate
Sinus Tachycardia
CASE 4
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

10. Typical AVNRT CASE 5 Regular, narrow complex - retrograde P-waves
RP < PR
RP < 80 ms
Typical AVNRT
CASE 5
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

11. Orthodromic AVRT CASE 6 Regular, narrow complex - retrograde P-waves
RP < PR
RP < 80 ms
Orthodromic AVRT
CASE 6
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

12. 2:1 AVNRT CASE 7 P-wave in the middle of RR - retrograde P-waves
Pseudo ‘R-waves
2:1 AVNRT
(Infrequent Presentations)
CASE 7
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

13. “2 x 1” Tachycardia CASE 8 Narrow complex Slightly irregular
1 P-wave, 2 QRS
“2 x 1” Tachycardia
CASE 8
P QRS QRS
Fast pathway
Slow pathway
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

14. Narrow Complex Tachycardia
Once Again…
Narrow Complex Tachycardia
Regular
P before QRS
Atrial Fibrillation
A. Flutter w/variab.con.
No P waves
- P after QRS + - ST
LAT
AVNRT JT
Saw tooth
A Flutter
RP<PR
RP>PR
AVRT
Atypical AVNRT
Irregular
November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation

15. www.HRMx.org www.doctorsfixinghearts.com November-30-18
Differential diagnosis in narrow QRS complex tachycardias Presentation