In this issue, we collaborated with the CJEM team to create a visual abstract on the article “Diagnosis and management of wide complex tachycardia in the emergency department”. 1
Seeing wide complex tachycardia in your patient should immediately trigger alarm bells. Despite having the potential to be lethal, the diagnosis and treatment of this arrhythmia in the emergency department (ED) setting has not been well studied. In this study, Linton et al. reviewed over 300 cases of wide complex tachycardia in the ED to assess for the accuracy of diagnosis by emergency physicians, and if subsequent treatment was appropriate.
The authors found that half of wide complex tachycardias were due to a primary cardiac arrhythmia, and half were secondary to an underlying medical condition (e.g. infection). Emergency physicians correctly diagnosed 81.2% of cases based off of the ECG, though they had a tendency to overcall atrial flutter and supraventricular tachycardia. Most cases were managed appropriately with some caveats: physicians were not able to control heart rate in 34% of secondary arrhythmias and 9% of primary arrhythmias. They failed to treat the underlying condition in 6% of secondary arrhythmias.
Overall, it can be said that emergency physicians are very good, but not perfect at managing this dangerous arrhythmia. This leaves us with opportunities to improve ECG interpretation and treatment strategies.
- Linton JJ, Eagles D, Green MS, Alchi S, Nemnom MJ, Stiell IG. Diagnosis and management of wide complex tachycardia in the emergency department. Can J Emerg Med. Published online January 23, 2022. doi:10.1007/s43678-021-00243-3