clinically detectable variation of the first heart sound and examination of the jugular venous pressure were noted to be useful for the diagnosis of a ventricular origin of the arrhythmia.3. 14. . In between, there is a WCT with a relatively narrow QRS complex with an RBBB-like pattern. In other words, the VT morphology shows the infarct location because VT most often arises from the infarct scar location. Below 60 BPM; Complexes are complete: P wave, QRS complex, T wave; NO wide, bizarre, early, late, or different . Key Features. Comments where: sinus rhythm with episodes of sinus tachycardia. These categories allow the selection of three groups of patients with clearly delineated QRS width: narrow (<90 ms), wide (>120 ms), and intermediate (90-119 ms). , Sinus Rhythm Types. , Zareba W, Cygankiewicz I, Long QT syndrome and short QT syndrome, Prog Cardiovasc Dis, 2008;51(3):26478. VA dissociation is best seen in rhythm leads II and V1. Baseline ECG shows sinus rhythm and a wide QRS complex with left bundle branch block-type morphology. A normal heartbeat is referred to as normal sinus rhythm (NSR). 4. 126-131. I. Vereckei A, Duray G, Szenasi G et al., Application of a new algorithm in the differentiatial diagnosis of wide QRS complex tachycardia, Eur Heart J, 2007;28,589600. 2007. pp. The ECG for a child or a pregnant woman can also feature a shorter interval of the P wave. He underwent electrophysiology study, where a wide complex tachycardia (right panel in Figure 6) was easily and reproducibly induced with programmed ventricular stimulation. Her rhythm strips from the ambulance are shown in Figure 5. PACs are extra heartbeats that originate in the top of the heart and usually beat . Figure 12: A 79-year-old woman with mitral valve stenosis and a dual-chamber pacemaker was admitted with fevers. , , Therefore, measurement of vital signs and a thorough but rapid physical examination are vital in deciding on the initial approach to the patient with WCT. The QRS complex in lead V1 shows an rS pattern, with a broad initial R wave, favoring VT (Table V). By the fourth wide complex beat, there is 1:1 VA conduction, and now there is VA association with a retrograde P wave (P). The recognition of variable intensity of the first heart sound (variable S1) can similarly be another clue to VA dissociation, and can help make the diagnosis of VT. Can I exercise? A, 12-Lead electrocardiogram obtained before electrophysiology study. We recommend using a protocol that one is most familiar and comfortable with and supplementing it with the steps from other protocols to improve the accuracy of the diagnosis. In this article we will discuss the factors which support the diagnosis of VT as well as some algorithms useful in the evaluation of regular, wide QRS complex tachycardias. On a practical matter, telemetry recordings are often erased once the patient leaves that location, and it is important to print out as many examples of the WCT as possible for future review by the cardiology or electrophysiology consultant. Twelve-lead ECG after electrical cardioversion of the tachycardia. Heart Rhythm. Name: Normal Sinus Rhythm Rate: 60-100 Rhythm: R-R intervals regular P-Waves: Present, all look alike PR-Interval: . Once again, the clinical scenario in which such a patient is encountered (such as history of antiarrhythmic drug use), along with other ECG findings (such as tall peaked T waves in hyperkalemia) will help make the correct diagnosis. proposed an algorithm for the differentiation of monomorphic wide QRS complex tachycardias.26 It consisted of four steps. Conclusion: SVT (AVRT utilizing a left-sided accessory pathway) with LBBB aberrancy. Recognition of intermittent cannon A waves on the jugular venous waveform (JVP) during ongoing WCT is an important physical examination finding because it implies VA dissociation, and can clinch the diagnosis of VT. Dendi R, Josephson ME, A new algorithm in the differential diagnosis of wide complex tachycardia, Eur Heart J, 2007;28:5256. Therefore, this tracing represents VT with 3:2 VA conduction (VA Wenckebach); this still counts as VA dissociation. Interpretation: Normal sinus rhythm with one PJC. This condition causes the lower heart chambers to beat so fast that the heart quivers and stops pumping blood. A 20-year-old man with recurrent supraventricular tachycardia ( Figure 1) was referred for catheter ablation. Chen PS, Priori SG, The Brugada Syndrome, JACC, 2008;51(12):117680. QRS duration 0,12 seconds. The WCT is at a rate of about 100 bpm, has a normal frontal axis, and shows a typical LBBB morphology; the S wave down stroke in V1-V3 is swift (<70 ms). [1] The normal resting heart rate for adults is between 60 and 100, which varies based on the level of fitness or the . Is sinus rhythm with wide QRS dangerous. Europace.. vol. The following observations can now be made: The underlying rhythm is now clearly exposed. Regularity of the rhythm: If the wide QRS tachycardia is sustained and monomorphic, then the rhythm is usually regular (i.e., RR intervals equal); an irregularly-irregular rhythm suggests atrial fibrillation with aberration or with WPW preexcitation. Published content on this site is for information purposes and is not a substitute for professional medical advice. Wide QRS tachycardia may be due to ventricular tachycardia (VT), supraventricular tachycardia (SVT) with aberrant conduction, or atrioventricular reentrant tachycardia (AVRT) with an accessory pathway. For management, see "Management of Wide Complex Tachycardia". Edhouse J, Morris F, ABC of clinical electrocardiography. C. Laboratory Tests to Monitor Response to, and Adjustments in, Management. This is called a normal sinus rhythm. Figure 1. The rhythm strip shows sinus tachycardia at the beginning and at the end; each sinus P wave is marked. Wide QRS = block is distal to the Bundle of His There may or may not be a pattern associated with the blocked complexes . , In EKG results, nonrespiratory sinus arrhythmia can look like respiratory sinus arrhythmia. The QRS width is useful in determining the origin of each QRS complex (e.g. The QRS complex in lead V1 shows an Rr morphology (first rabbit ear is taller than the second), favoring VT (Table IV). The QRS complex duration is wide (>0.12 seconds or 3 small boxes) in every lead. Hanna Ratcovich In other words, the default diagnosis is VT, unless there is no doubt that the WCT is SVT with aberrancy. Khairy P, Harris L, Landzberg MJ, et al., Implantable cardioverterdefibrillators in tetralogy of Fallot, Circulation, 2008;117:36370. Danger: increase the risk of thromboemoblic events don't convert unless occurring less than 48 hrs, if don't know pt need to be put . Although this is an excellent protocol, with a sensitivity of 8892 % and specificity of 4473 % for VT, it requires remembering multiple morphologic criteria.25,26, The majority of the protocols use supraventricular tachycardia as a default diagnosis of wide QRS complex tachycardia. Careful attention should subsequently be paid to the potential change in the width and axis of the QRS complex when comparing it to the QRS complex of the baseline ECG. Her initial ECG is shown. Any cause of rapid ventricular pacing will result in result in a WCT. 2 years ago. In cases of respiratory sinus arrhythmia, the P-P interval will often be longer than 0.16 seconds when the person breathes out. A sinus rhythm result means the heart is beating in a uniform pattern between 50 and 100 BPM. Medications should be carefully reviewed. This is achieved by rapid propagation along the common bundle of His, the right and left bundle branches, the fascicles of the left bundle branch, and the Purkinje network. Pill-in-the-pocket Oral Anticoagulation in AF Patients, Antithrombotic Therapy in AF-PCI Patients, Angiographic Characteristics in Older NSTEACS Patients, TMVR via MitraClip in Patients Aged <65 Years: Multicentre 2-year Outcomes, Approach to the Differentiation of Wide QRS Complex Tachycardias, Content for healthcare professionals only, Persistent Atrial Fibrillation Using Arctic Front Cardiac Cryoablation System, American Heart Hospital Journal 2011;9(1):33-6, https://doi.org/10.15420/ahhj.2011.9.1.33. The prognostic value of a wide QRS >120 ms among patients in sinus rhythm is well established. Ventricular rhythm (Fgure 6) Characterized by wide QRS complexes that are not preceded by P waves. - Full-Length Features The differentiation of wide QRS complex tachycardias remains a diagnostic challenge (see Table 2). Sick sinus syndrome is a type of heart rhythm disorder. A change in the QRS complex morphology or axis by more than 40, as well as a QRS axis of 90 to 180 suggests a ventricular origin of the arrhythmia. When a sinus rhythm has a QRS complex of 0.12 sec or greater, you know that this is an abnormality & would note that it has: a wide QRS accelerated ventricular conduction Purkinje disease . The precordial leads show negative complexes from V1 to V6so called negative concordance, favoring VT. And you dont want to, because its a sign of a healthy heart. Cleveland Clinic is a non-profit academic medical center. Goldberger, ZD, Rho, RW, Page, RL.. Approach to the diagnosis and initial management of the stable adult patient with a wide complex tachycardia. Such a re-orientation of lead I electrodes so that they straddle the right atrium, often allows more accurate recognition of atrial activity, and if dissociated P waves are seen, the diagnosis of VT is established. But people with this type usually: Providers can identify ventriculophasic sinus arrhythmia by looking at the electrocardiogram (EKG) results. Figure 2. incomplete right bundle branch block. It is atrial flutter with grouped beating. The ECG shows a normal P wave before every QRS complex. Lau EW, Pathamanathan RK, Ng GA, The Bayesian approach improves the electrocardiographic diagnosis of broad complex tachycardia, Pacing Clin Electrophysiol, 2000;23(10 Pt 1):151926. Tachycardias are broadly categorized based upon the width of the QRS complex on the electrocardiogram (ECG). General approach to the ECG showing a WCT. It affects the heart's natural pacemaker (sinus node), which controls the heartbeat. Because ventricular activation occurs over the RBB, the QRS complex during this VT exactly resembles the QRS complex during SVT with LBBB aberrancy. Sinus tachycardia is when your body sends out electrical signals to make your heart beat faster. In its commonest form, the impulse travels down the RBB, across the interventricular septum, and then up one of the fascicles of the left bundle branch. Jastrzebski, M, Sasaki, K, Kukla, P, Fijorek, K. The ventricular tachycardia score: a novel approach to electrocardiographic diagnosis of ventricular tachycardia. II. If your QRS complex is longer than 0.12 seconds, it is considered wide. A common reason for this is premature atrial contractions (PACs). 15. Garrat CJ, Griffith MJ, Young G, et al., Value of physical signs in the diagnosis of ventricular tachycardias, Circulation, 1994;90:31037. The standard interval of the P wave can also range as low as ~90 ms (0.09s) until the onset of the QRS complex. Read an unlimited amount by logging in or registering at no cost. A history of ischemic heart disease or congestive heart failure is 90 % predictive of a ventricular origin of an arrhythmia.4 Patients with hypertrophic obstructive cardiomyopathy are prone to have VT.5 A known history of arrhythmogenic right ventricular dysplasia or cathecolaminergic polymorphic VT should also point towards a ventricular origin of the tachycardia. Pacing results in a wide QRS complex since the wave front of depolarization starts in the myocardium at the ventricular lead location, and then propagates by muscle-to-muscle spread. ( over 0.10 seconds) is caused by delayed conduction of the electrical stimulus from the upper chamber which causes a delay in contraction of the ventricles. Leads V2 and V3, however, show swift down strokes (onset to nadir <70 ms), favoring SVT with LBBB aberrancy. The frontal axis is pointing to the right shoulder, and favors VT. The normal PR interval range is ~120 - 200 ms (0.12-0.20s), although it can fluctuate depending on your age and health. pp. Occasional APBs and one ventricular run. QRS Width. All rights reserved. If the sinus node fails to initiate the impulse, an atrial focus will take over as the pacemaker, which is usually slower than the NSR. There is (negative) precordial concordance, favoring VT. It must be acknowledged that there are many clinical scenarios where different criteria will provide conflicting indications as to the etiology of a WCT. Capturing the onset or termination of WCT on telemetry strips can be especially helpful. The QRS complex during WCT and during sinus rhythm are nearly identical, and show LBBB morphology. The WCT shows a QRS complex duration of 180 ms; the rate is 222 bpm. However, the correct interpretation requires recognition that the narrow complexes are too narrow to be QRS complexes, and are actually pacemaker spikes with failure to capture the myocardium. If an old EKG is available, the baseline wide QRS will be present. This collection of propagating structures is referred to as the His-Purkinje network.. 2016. pp. It should be noted that hemodynamic stability is not always helpful in deciding about the probable etiology of WCT. A Junctional rhythm can happen either due to the sinus node slowing down or the AV node speeding up. An electrocardiogram (EKG) can tell your provider if you have sinus arrhythmia. Depending on your pre disposing factors for coronary artery disease, and your symptoms, if any. Figure 7: The telemetry strip shown in Figure 7 (lead MCL or V1) was recorded in a 42-year-old man with no cardiac history. 2008. pp. Figure 10 and Figure 11: A 62-year-old man without known heart disease but uncontrolled hypertension developed palpitations and light-headedness that prompted him to visit his doctor. , Oreto G, Smeets JL, Rodriguez LM, et al., Wide complex tachycardia with atrioventricular dissociation and QRS morphology identical to that of sinus rhythm: a manifestation of bundle branch reentry, Heart, 1996;76(6):5417. The ECG recorded during sinus rhythm . The normal QRS complex during sinus rhythm is narrow (<120 ms) because of rapid, nearly simultaneous spread of the depolarizing wave front to virtually all parts of the ventricular endocardium, and then radial spread from endocardium to epicardium. 1. There are 5 classic causes of wide complex tachycardia mechanisms: The copyright in this work belongs to Radcliffe Medical Media. He proceeded to have an episode of WCT while in bed with dizziness and drop in blood pressure, which self-terminated. Conclusion: Atrial flutter with 2:1 AV conduction with preexisting RBBB and LPFB. A prolonged PR interval suggests a delay in getting through the atrioventricular (AV) node, the electrical relay . Introduction. Description. It is not affiliated with or is an agent of, the Oxford Heart Centre, the John Radcliffe Hospital or the Oxford University Hospitals NHS Foundation Trust group. , Comparison with the baseline ECG is an important part of the process. Vaugham Williams Class I and Class III antiarrhythmic medications, multiple medications that prolong the QT, and digoxin at toxic levels may cause VT. A careful review of the electrocardiogram (ECG) may provide clues to the origin of a wide QRS complex tachycardia. However, it should be noted that the dissociated P waves occur at repeating locations. The flutter waves are marked by arrows (). Articles marked Open Access but not marked CC BY-NC are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. The term narrow QRS tachycardia indicates individuals with a QRS duration 120 ms, while wide QRS tachycardia refers to tachycardia with a QRS duration >120 ms. 1 Narrow QRS complexes are due to rapid activation of the ventricles via the His-Purkinje system, suggesting that the origin of the arrhythmia is above or within the His bundle. Register for free and enjoy unlimited access to: The QRS complex is wide, measuring about 130 ms; the frontal axis is rightward and inferior, suggestive of left posterior fascicular block (LPFB). Circulation. Unfortunately AV dissociation only . This is one VT where the QRS complex morphology exactly mimics that of SVT with aberrancy. AIVR is a wide QRS ventricular rhythm with rate of 40-120 bpm, often with variability during the episode. Vijay Kunadian et al, Andre Briosa e Gala premature ventricular contraction. Since respiratory sinus arrhythmia is normal, people without symptoms rarely need treatment. Huemer, M, Meloh, H, Attanasio, P, Wutzler, A. sinus, atrial, junctional or ventricular). Sinus arrhythmia is a kind of arrhythmia (abnormal heart rhythm). Wide complex tachycardia related to preexcitation. Normal sinus rhythm is defined as a regular rhythm with an overall rate of 60 to 100 beats/min. Sarabanda AV, Sosa E, Simes MV, et al., Ventricular tachycardia in Chagas' disease: a comparison of clinical, angiographic, electrophysiologic and myocardial perfusion disturbances between patients presenting with either sustained or nonsustained forms, Int J Cardiol, 2005;102(1):919. When sinus rhythm exceeds 100 bpm, it is considered sinus tachycardia. I have the Kardia and have the advanced determination so it records 6 arrhythmias. A 70-year-old woman with prior inferior wall MI presented with an episode of syncope resulting in lead laceration, followed by spontaneous recovery by persistent light-headedness. Sinus bradycardia occurs when your sinus rhythm is below 60 bpm. Maron BJ, Estes NA 3rd, Maron MS, et al., Primary prevention of sudden death as a novel treatment strategy in hypertrophic cardiomyopathy, Circulation, 2003;107(23):28725. When you take a breath, your heart rate goes up. Sometimes, these electrical impulses are sent out faster than this typical rhythm, causing sinus tachycardia. The wider the QRS complex, the more likely it is to be VT. She has missed her last two hemodialysis appointments. However, there is subtle but discernible cycle length slowing (marked by the *). ECG results: 79 pbm, Pr interval 152 ms, Qrs duration 100 ms,QT/QTc 352/403 ms, p r t axes 21 20 17. Note that as the WCT rate oscillates, the retrograde P waves follow the R-R intervals. Sinus arrhythmia is a kind of arrhythmia (abnormal heart rhythm). Cardiac monitoring and treatment for children and adolescents with neuromuscular disorders, Dev Med Child Neurol, 2006;48:2315. Sinus rythm with marked sinus arythmia. If the ambient sinus rate is rapid, the resulting ECG may show a WCT. Latest News Your top articles for Saturday, Continuing Medical Education (CME/CE) Courses. Broad complexes (QRS > 100 ms) may be either ventricular . This is traditionally printed out on a 6-second strip. This is where the experienced electrocardiographer must weigh the conflicting indicators and reach a clinical decision. 578-84. Relation to age, timing of repair, and haemodynamic status, Br Heart J, 1984;52(1):7781. The ECG in Figure 4 is representative. Evidence of fusion beats or capture beats is evidence for VA dissociation, and clinches the diagnosis of VT. ECG evidence of even a single dissociated P wave at the onset of tachycardia (i.e., AV dissociation at the onset) may be sufficient evidence on a telemetry strip to recognize VT. Its usually a sign that your heart is healthy. However, you need to understand the following (sorry to seem a bit brutal here..) Your condition is possibly serious (hypertension >200 mmHg systolic with slight exercise, angina pectoris at age 31 . 4(a) Due to sinus arrest; 4(b) Due to complete heart block; ECG 5(a) ECG 5(b) ECG 5 Interpreation. For left bundle branch block morphology the criteria include: for V12: an R wave of more than 30 ms duration, notching of the downstroke of the S wave, or duration from the onset of the QRS to the nadir of S wave of more than 70 ms; for lead V6: the presence of a QR or RS complex. Scar tissue, as seen in patient with prior myocardial infarctions or with cardiomyopathy, may further slow intramyocardial conduction, resulting in wider QRS complexes in both situations. 39. Figure 4: A 57-year-old woman with palpitations for many years and idiopathic globally dilated cardiomyopathy was admitted for incessant wide complex tachycardia. The sinus node is a group of cells in the heart that generates these impulses, causing the heart chambers to contract and relax to move blood through the body. by Mohammad Saeed, MD. 2012 Aug. pp. Thick black lines are printed every 3 seconds, so the distance between 3 black lines is equal to 6 seconds. A rapid pulse was detected, and the 12-lead ECG shown in Figure 10 was obtained. Am J of Cardiol. I gave a Kardia and last night I upgraded the Kardia and my first reading was Sinus rhythm with wide QRS and I was concerned because my left side was hurting and I also had a cramp in my back . This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. et al, Antonio Greco When a WCT abruptly becomes a narrow complex tachycardia with acceleration of the heart rate, SVT (orthodromic atrioventricular reciprocating tachycardia using an accessory pathway on the same side as the blocked bundle branch) is confirmed (Coumels law). Carla Rochira , Vereckei A, Duray G, Szenasi G, et al., New algorithm using only lead aVR for differential diagnosis of wide QRS tachycardias, Heart Rhythm, 2008;5(1):8998. If you have respiratory sinus arrhythmia, your outlook is good. Interpretation = Ventricular Escape Rhythms. Grant C. Fowler MD, in Pfenninger and Fowler's Procedures for Primary Care, 2020 Right Axis Deviation (Not Present on Prior Electrocardiograms) When right axis deviation is a new finding, it can be due to an exacerbation of lung disease, a pulmonary embolus, or simply a tachycardia. And its normal. His echocardiogram showed a severely dilated heart with ejection fraction estimated at 10% to 15%. Sinus rythm with mark. Rhythms (From ECG Book) a. For the final assessment at least one criterion for both V12 and V6 have to be present to diagnose VT. The ESC textbook of Cardiovascular Medicine, Oxford, Blackwell Publishing Ltd, 2006, p950. , The ECG shows atrial fibrillation with both narrow and wide QR complexes. No. As expected, the P waves are of low amplitude in hyperkalemia. 2. The QRS morphology suggests an old inferior wall myocardial infarction, favoring VT. This is also indicative of VT (ventricular oscillations precede and predict atrial oscillations). Escardt L, Brugada P, Morgan J, Breithardt G, Ventricular tachycardia. The R-wave may be notched at the apex. Wide complex tachycardia is defined as a rate of > 100 with QRS > 120ms. (Never blacked out) Bjoern Plicht He had a history of paroxysmal atrial fibrillation. The normal PR interval is 0.12-0.20 seconds, or 3-5 small boxes on the ECG graph paper. What determines the width of the QRS complex? You cant prevent respiratory sinus arrhythmia. In general, the presence of scar can be inferred from QRS complex fractionation or splintering or notching.. 28. Its rare for people to have symptoms of sinus arrhythmia. Regularity of the rhythm: If the wide QRS tachycardia is sustained and monomorphic, then the rhythm is usually regular (i.e., RR intervals equal); an irregularly-irregular rhythm suggests atrial fibrillation with aberration or with WPW preexcitation. Heart, 2001;86;57985. the algebraic sum of the voltage of the first 40 ms divided by the last 40 ms is less than or equal to one. Table 1 summarizes the Brugada and Vereckei protocols. If the patient is conscious and cardioversion is decided upon, it is strongly recommended that sedation or anesthesia be given whenever possible prior to shock delivery. This is one VT which meets every QRS morphology criterion for SVT with aberrancy. Kindwall, KE, Brown, J, Josephson, ME.. Electrocardiographic criteria for ventricular tachycardia in wide complex left-bundle branch block morphology tachycardias. B. This is done by simply judging the QRS duration. et al, Benjamin Beska If the QRS duration is prolonged (0.12 seconds), the arrhythmia is a wide complex tachycardia (WCT). This rhythm has two postulated, possibly coexisting . The pattern of preexcitation in sinus rhythm (the delta wave) will be exactly reproduced (and exaggerated so called full preexcitation) during antidromic AVRT. vol. 83. , An abnormally slow heartbeat is called bradycardia, while an abnormally fast heartbeat is called tachycardia. When VT occurs in patients with prior myocardial infarction, the QRS complex during VT shows pathologic Q waves in the same leads that showed pathologic Q waves in sinus rhythm. There are two main types of bradycardiasinus bradycardia and heart block. Lau EW, Ng GA, Comparison of the performance of three diagnostic algorithms for regular broad complex tachycardia in practical application, Pacing Clin Electrophysiol, 2002;25(5):8227. This causes a wide S-wave in V1V2 and broad and clumsy R-wave in V5V6. Dual-chamber pacemakers may show rapid ventricular pacing as a result of tracking at the upper rate limit, or as a result of pacemaker-mediated tachycardia. Last reviewed by a Cleveland Clinic medical professional on 03/21/2022. . This kind of arrhythmia is considered normal. Aberrancy implies the patient has an EKG with baseline wide QRS (from a bundle branch block (BBB)). The timing of engagement of the His-Purkinje network: at some point during propagation of the VT wave front, the His-Purkinje network is engaged, resulting in faster propagation; the earlier this occurs, the narrower the QRS complex. There is precordial (positive) concordance, favoring VT. Lead aVR shows a broad Q wave, favoring VT. Get useful, helpful and relevant health + wellness information. You probably don't think much about your heartbeat because it happens so easily. Respiratory sinus arrhythmia is usually normal and doesnt have symptoms, but the conditions below arent normal and do have symptoms. Dhoble A, Khasnis A, Olomu A, Thakur R, Cardiac amyloidosis treated with an implantable cardioverter defibrillator and subcutaneous array lead system: report of a case and literature Review, Clin Cardiol, 2009;32(8):E635. While it may seem odd to call an abnormal heart rhythm a sign of a healthy heart, this is actually the case with sinus arrhythmia. The Q wave in aVR is >40 ms, favoring VT. Although initial perusal may suggest runs of nonsustained VT, careful observation reveals that there is a clear pacing spike prior to each wide QR complex (best seen in lead V4), making the diagnosis of a paced rhythm. Updated. What causes a junctional rhythm in the sinus? Bundle Branch Block; Accessory Pathway; Ventricular rhythm Ventricular escape rhythm; AIVR - Accelerated Idioventricular Rhythm; - And More, Close more info about Differential Diagnosis of Wide QRS Complex Tachycardias. However, early activation of the His bundle can also . Application of irrigated radiofrequency current to a site 8 mm below the apex of Koch's triangle was terminated . If the dangerous rhythm does not correct itself, then a life-threatening arrhythmia called ventricular fibrillation follows.
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