Wide QRS Tachycardias: Aberrant Conduction or Ventricular Origin?

A correct diagnosis of a wide QRS tachycardia on standard 12-lead ECG can be challenging. The correct analysis of the ECG tracing is an extremely useful tool to distinguish a supraventricular from a ventricular tachycardia. The right diagnosis has important clinical implications. We analyzed the traditional criteria, the Brugada’s and the Verekei’s algorithms together with the early-phase analysis of ventricular depolarization (the intrinsicoid deflection or R wave peak time) as important diagnostic steps. Four clinical cases of wide QRS, tachycardias are here described together with the process description that leads to the final diagnosis.