In the evaluation of older patients with syncope, certain ECG abnormalities increase the risk of 30-day serious cardiac arrhythmias. These ECG abnormalities include non-sinus rhythm; multiple premature ventricular conductions; short PR interval; first degree atrioventricular block; complete left bundle branch block; and ST, T, and Q-wave abnormalities consistent with acute or chronic ischemia.
This retrospective dredge of the ROMICAT-II trial found that clinical evaluation alone had decreased length of stay (LOS) and appeared to be just as safe with respect to major adverse coronary events as those who had non-invasive testing, with lower cost and radiation exposure.
The differential of wide complex tachycardia (WCT) includes ventricular tachycardia (VT) and supraventricular tachycardia with aberrant conduction (SVT-AC). The summary below provides some tips for differentiating the two. However, if you are unsure it is always prudent to assume VT until proven otherwise.