Wide Complex Tachycardia Differentiation: A Reappraisal of the State-of-the-Art

J Am Heart Assoc. 2020 Jun 2;9(11):e016598. doi: 10.1161/JAHA.120.016598. Epub 2020 May 19.


The primary goal of the initial ECG evaluation of every wide complex tachycardia is to determine whether the tachyarrhythmia has a ventricular or supraventricular origin. The answer to this question drives immediate patient care decisions, ensuing clinical workup, and long-term management strategies. Thus, the importance of arriving at the correct diagnosis cannot be understated and has naturally spurred rigorous research, which has brought forth an ever-expanding abundance of manually applied and automated methods to differentiate wide complex tachycardias. In this review, we provide an in-depth analysis of traditional and more contemporary methods to differentiate ventricular tachycardia and supraventricular wide complex tachycardia. In doing so, we: (1) review hallmark wide complex tachycardia differentiation criteria, (2) examine the conceptual and structural design of standard wide complex tachycardia differentiation methods, (3) discuss practical limitations of manually applied ECG interpretation approaches, and (4) highlight recently formulated methods designed to differentiate ventricular tachycardia and supraventricular wide complex tachycardia automatically.

Keywords: ECG; supraventricular tachycardia; ventricular tachycardia; wide complex tachycardia.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Action Potentials*
  • Animals
  • Diagnosis, Differential
  • Electrocardiography*
  • Electrophysiologic Techniques, Cardiac*
  • Heart Conduction System / physiopathology*
  • Heart Rate*
  • Humans
  • Predictive Value of Tests
  • Tachycardia, Supraventricular / diagnosis*
  • Tachycardia, Supraventricular / physiopathology
  • Tachycardia, Ventricular / diagnosis*
  • Tachycardia, Ventricular / physiopathology
  • Time Factors