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.


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