Wide Complex Tachycardia - what does it mean ?

[Drosophila]

Background: I had a number of syncope episodes / hospital stays 4-5 years ago with a range of cardiac arhymithias, bradycardia, hypotension and bi-tri-Gemini, and LOTS of ectopics. I felt absolutely terrible and was off work for 4 months and during that time they fitted a loop recorder and put me on beta blockers (now up to 2x 2.5mg bisolprolol ) which helped massively.

Over the intervening years I have had a number of brief episodes of non-sustained ventricular tachycardia recorded by the loop recorder. The first time they pulled me in for an urgent appointment, but they now seem to not really worry too much about these (other than increasing my beta blocker dose). In January I woke up in the middle of the night with violent palpitations and triggered the recorder. This led to a letter last week saying that I had had 68 beats of ‘wide complex tachycardia’ and could I please Email to discuss what I wanted to do (!).

Are 68 beats a lot ?? Dr Google makes this many wide / broad complex tachycardia beats sound quite scary. But then, almost any symptom can sound scary if you Google it too deeply.

However, the fact that this recent episode happened at night, my previous syncope episodes and the fact that my grandfather died suddenly in his sleep of ‘heart issues’ made me worry if I might have Brugadas Syndrome. But maybe I’m just being paranoid…

I have written back to the cardiologist but havent heard anything back as yet, and with the NHS as stretched as it is, it’s possible this could take some time. In the meantime, the potential prospect of a ‘sudden cardiac death’ is rather unsettling.

Am I over reacting and would I be better just leaving everything to the Drs ? Or are they being amazingly lax with something that could kill me any time ? Thoughts ?

[Thecyclist]

Hi, Wide complex tachycardia can be NSVT, any tachycardia that has a QRS of more than 120 milliseconds is a "wide complex" by definition, normal SR QRS complex is less than 120ms. The QRS is the spike in an ECG, it represents the depolarisation of the ventricle, hence it is ventricular in origin. I had the same diagnosis from a consultant that wasn't a Cardiologist or EP. I did the same and read up and it was pretty scary. However when I eventually met the EP he just said is was NSVT. I had 10 beats. NSVT is a wide complex tachycardia of less than 30 seconds. More than is VT.

Sounds like you have a structurally normal heart? In which case, the doctors are less concerned. In the case of CHD and other diseases of the heart then it can be a concern. I had an angiogram that confirmed my heart was good so they were not so concerned, I have not had any syncope though. I must say that any NSVT or runs I do have, scare the pants off me, and leave me off kilter for a day or so. I've been on 5mg Bisop for nearly 4 years and it seems to make little difference to the runs or the palpitations.

Was it 68 beats in a row? Brugada syndrome is something very different, and if the doctor was concerned it was that you would have been seen much more urgently.

I wouldn't read doctor google, I think think the wide complex stuff you read on there is very much VT related so although the same wide complex is something very different.

In any case I would caveat all I said and speak to your cardiologist or EP before anything, I am only relaying what I have found out based on my diagnosis and symptoms.

[Drosophila in reply to Thecyclist]

Thanks, given my history of VT and the fact that 80% of wide complex VT is ventricular in origin, my assumption is that this latest event (yes all in one run I think) is ventricular based.

Structurally, I have a couple of slightly leaky valves apparently, but structurally OK otherwise according to cardiac MRI.

The worry for me has been that up to now my max VT run duration has been 10-12 beats, so 68 seems like quite a lot and it really left me gasping at the time. The good news is that it’s always resolved by itself (so far), but I guess my main question is whether thats going to keep being the case if the runs get even longer. And at which point it gets properly dangerous.

[Drosophila]

Only 20% of Brugada patients have a detectable mutation in SCN5A, so genetic testing isnt that useful at the moment unfortunately…