Wide Complex Tachycardia: The Life-Threatening Rhythm Every Nurse Must Recognize Immediately

Wide complex tachycardia (WCT) is any rhythm faster than 100 beats per minute with a QRS duration of 120 milliseconds or more. At the bedside it is a time-critical finding: until proven otherwise, WCT is ventricular tachycardia.

The safest clinical habit is to treat sustained WCT as VT and prioritise assessment of perfusion. A patient who is unstable — hypotensive, altered, with chest pain or signs of shock — needs synchronised cardioversion without waiting for a 12-lead.

For the stable patient, a 12-lead ECG lets you look for the features that favour VT: AV dissociation, fusion and capture beats, extreme axis deviation, and concordance across the precordial leads.

Our Advanced Arrhythmia Recognition course covers the full differentiation algorithm with worked examples.