Advanced EKGs - Distinguishing VT from SVT with aberrancy

[@franptsn5023]

Approaching 1 year as a cardiac physiologist. Thank you so much for your clear explanations! Highly appreciated

[@vt2788]

I am a trainee sort of general cardiologist and have learned a lot from your videos! They are of the highest scientific quality and very entertaining. Thank you!

[@studentforlife9687]

Thank you so much from Morocco Dr Strong !

[@ΆγιοςΧίλαριος]

Great thanks for the video ! I've seen a case of hyperkalemia with regular WCT and very wide QRS ~ .2 sec which resolved completely with IV Ca gluconate . I'm not sure if antidromic AVRT would be called aberrancy as this refers to tachycardia-related RBBB/LBBB. Also, I read somewhere that BBR-VT can present with a QRS morphology that resembles the baseline EKG.

[@StrongMed]

Great points! Yes, I agree there is a problem with how the word "aberrancy" is used in this context. For some reason, at least in the US, clinicians often refer to this dichotomy of "VT versus VT with aberrancy" when what they really mean is more accurately "VT vs. a non-VT WCT". In the strictest sense, I think most electrophysiologists use "aberrancy" to refer to the situation in which a supraventricular impulse travels through proximally-to-distally through the His-Purkinje system but results in an abnormal sequence of ventricular depolarization due to a problem within the His-Purkinje system itself (e.g. rate-related BBB, intrinsic IVCD). So in short, an electrophysiologist would not refer to antidromic AVRT as an "SVT with aberrancy" even though the majority of discussions of how to distinguish different types of WCT imply it belongs in this category. Yes, BBRVT can be indistinguishable on ECG from SVT + preexisting BBB (usually LBBB), and thus not be identified with the standard VT vs. SVT + aberrancy algorithms. Features that suggest the possibility of BBRVT are an unusually fast rate (>=200 bpm), hemodynamic instability, and severe underlying structural heart disease

[@4dracha]

BBR and fascicular VT can have relatively narrow complex. Many textbooks refer to antidromic AVRT as preexcited svt, keeping the term aberracy for BBB(fixed or transient) and IVCD

[@medstudentbloop]

Please more ECG videos 🙂i love this channel🥰

[@biancabrown1223]

I’m a new nurse. And find myself struggling a bit, but this helps! Thanks

[@وسيمصوفان-ك6ه]

Excellent explanation

[@Sharmi-ir2jf]

Hello Dr Strong! I want to thank you first and foremost for all your carefully made videos. Secondly, I have a small question. I am halfway through your series on EKG interpretation. Do you have any review questions that you would personally recommend, yours or any educational body I can easily access on the web? A grateful med student! I would like as much revision as I can, and I’ve done the the ones included in the videos

[@StrongMed]

The best sites for doing EKG questions required paid subscription, but Life In The Fast Lane has curated a list of the web's best paid and free EKG resources here: litfl.com/top-20-online-ecg-courses/ However, they are strangely missing one of the first (and in my opinion, best) free sites for learning EKGs: ecg.utah.edu/

[@mahwish5203]

Excellent 👍🏻👍🏻👍🏻

[@yasirmohammedali]

Hello doctor, thank you for your help

[@mataanciiideed4046]

Thank you for your efforts

[@beccaf4533]

Excellent! Thank you!

[@joshuahaywood7933]

Thank you so much Dr Strong You a g for dis one

[@tvo3205]

i love the detailed EKG videos!

[@getnettilahun6390]

excellent!!

[@mcardio1287]

Excellent

[@Propofol1234]

Hi Dr Strong How do you know where the QRS complex is pointing in these VTs? It is hard to identify an isolelectric line

[@abudaniyal715]

Thanks

[@shehzadsaab6051]

Very helpful, but need time to retain all these. I should play it again and again. 😢

[@nawafnawaf2538]

Thaaaaaanks❤

[@josephgarribaldi2481]

In the AV dissociation strip how come is it said to be wide or borderline wide cause those QRSs' complexes look

[@kaze123ckr]

How can one know the onset of the QRS complex to apply the brugada sign? (R-S interval)

[@andonisangelov193]

What is the reason for S wave in lead V6 in normal ECG?

[@junnyhaan]

I have a question. I can not understand 7:12.(you explained R-S > 100ms is the critical point of VT) Why did you set up R wave starting point on the first notching on the down slope? Regardless of brugada sign is superior axis or inferior axis, R wave starting point should be the highest point on brugada wave. Please, someone will make me understand.

[@StrongMed]

That's a great question which I probably should have clarified in the video. In short, what is called the "R to S" in this context (including in the medical literature) refers to the time interval between the very beginning of the QRS complex and S wave nadir, irrespective of whether the QRS starts with a Q wave or R wave. It's misleading terminology, thus, why "R to S" is placed in quotes in the image.

[@zee1645]

Its onset of R to nadir of S. I highly suggest you to read about the brugada criteria.

[@samirsahu2490]

Excellent content, well explained, and of high levels

[@onwong5378]

Thanks