Polymorphic Wide QRS Complex Tachycardia: Differential Diagnosis

Zeynab Jebberi; Jacopo Marazzato; Roberto De Ponti; Giuseppe Bagliani; Fabio M Leonelli; Serge Boveda

doi:10.1016/j.ccep.2019.02.004

Polymorphic Wide QRS Complex Tachycardia: Differential Diagnosis

Card Electrophysiol Clin. 2019 Jun;11(2):333-344. doi: 10.1016/j.ccep.2019.02.004. Epub 2019 Apr 12.

Authors

Zeynab Jebberi¹, Jacopo Marazzato², Roberto De Ponti², Giuseppe Bagliani³, Fabio M Leonelli⁴, Serge Boveda⁵

Affiliations

¹ Cardiac Arrhythmia Management Department, Clinique Pasteur, BP 27617, 45 Avenue de Lombez, Toulouse 31076, France.
² Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation, University of Insubria, Viale Borri, 57, Varese 21100, Italy.
³ Cardiology Department, Arrhythmology Unit, Foligno General Hospital, Foligno, Via Massimo Arcamone, Foligno, Perugia 06034, Italy; Cardiovascular Diseases Department, University of Perugia, Piazza Menghini 1, Perugia 06129, Italy.
⁴ Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA.
⁵ Cardiac Arrhythmia Management Department, Clinique Pasteur, BP 27617, 45 Avenue de Lombez, Toulouse 31076, France. Electronic address: sboveda@clinique-pasteur.com.

PMID: 31084854
DOI: 10.1016/j.ccep.2019.02.004

Abstract

Polymorphic wide QRS complex tachycardia is defined as a tachyarrhythmia showing variable and frequently alternating morphologies of the QRS complex with irregular R-R intervals. It may present with a specific and reproducible pattern including torsade de pointes and bidirectional ventricular tachycardia or with a nonspecific and very irregular pattern, different from ventricular fibrillation. Polymorphic ventricular tachycardia is a challenging diagnosis and is associated with a high risk for sudden cardiac death. Although rare, preexcited atrial fibrillation over multiple accessory pathways can also generate a polymorphic wide QRS complex tachycardia mimicking polymorphic ventricular tachycardia.

Keywords: Afterdepolarizations; Bidirectional ventricular tachycardia; Phase 2 reentry; Polymorphic ventricular tachycardia; Preexcited atrial fibrillation; Torsade de pointes; Ventricular fibrillation.

Publication types

Review

MeSH terms

Atrial Fibrillation / diagnosis
Atrial Fibrillation / physiopathology
Diagnosis, Differential
Electrocardiography*
Humans
Tachycardia, Ventricular* / diagnosis
Tachycardia, Ventricular* / physiopathology
Ventricular Fibrillation / diagnosis
Ventricular Fibrillation / physiopathology