Supraventricular tachycardia (SVT) with aberrant conduction

Any of the previously discussed narrow-complex tachy-dysrhythmias can be accompanied by aberrant conduction (Figure 4.16). This can be either a left or right bundle branch block pattern. The following criteria suggest a supraventricular rhythm with aberrancy rather than VT:

1.  A bundle branch morphology identical to that of the previous 12-lead ECG

2.  An ectopic P wave that precedes the QRS complex

3.  Variable coupling intervals between beats

4.  Response to adenosine or carotid sinus massage (SVT with aberrancy will usually respond with a slowing of the heart rate and possible termination of the dysrhythmia, whereas VT typically does not)

When in doubt, it is safest and most appropriate to assume the rhythm disturbance is VT and treat accordingly. The treatment for all unstable patients is synchronized electrical cardioversion.

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