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Other Tachycardia Rhythms

There are several other tachycardia rhythms that can be seen with both stable and
unstable tachycardia. These rhythms include monomorphic ventricular
tachycardia and polymorphic ventricular tachycardiaboth of which are wide-complex
Wide complex tachycardias are defined as a QRS of 0.12 second. Expert consultation
should be considered with these rhythms.

These wide-complex tachycardias are the most common forms of tachycardia that will
deteriorate to ventricular fibrillation.

Monomorphic Ventricular Tachycardia

With monomorphic VT all of the QRS waves will be symmetrical. Each ventricular
impulse is being generated from the same place in the ventricles thus all of the QRS
waves look the same.
Treatment of monomorphic VT is dependent upon whether the patient is stable or
unstable. Expert consultation is always advised, and if unstable, the ACLS tachycardia
algorithm should be followed.

Polymorphic Ventricular Tachycardia

With polymorphic ventricular tachycardia, the QRS waves will not be symmetrical. This is
because each ventricular impulse can be generated from a different location. On the
rhythm strip, the QRS might be somewhat taller or wider.
One commonly seen type of polymorphic ventricular tachycardia is torsades de pointes.
Torsades and other polymorphic VT are advanced rhythms which require additional
expertise and expert consultation is advised.
If polymorphic VT is stable the ACLS tachycardia algorithm should be used to treat the
patient. Unstable polymorphic ventricular tachycardia is treated with unsynchronized
shocks (defibrillation). Defibrillation is used because synchronization is not

These wide complex tachycardias tend to originate in the ventricles rather than like a
normal rhythm which originates in the atria.