Wide QRS Complex Tachycardia with Negative Precordial Concordance: Always a Ventricular Origin?

Wide‐QRS‐Complex Tachycardia with a Negative Concordance Pattern in the Precordial Leads: Are the ECG Criteria Always Reliable?

“…Differential diagnosis of tachycardias in patients with special anatomical characteristics can also be misleading. Volders and colleagues have recently presented a similar case, which was attributed to morphological abnormalities of the patient's chest 5 . Our patient was obese, and hence, anatomically based particular orientation of the heart vector cannot be excluded, even though we observed no specific chest deformity, nor abnormal position of the heart in our patient's chest.…”

Limitations of the negative concordance pattern in the diagnosis of broad QRS tachycardia

“…9,16-23 Two such cases involved atrioventricular (AV) nodal reentrant tachycardia, 18,20 and 3 cases involved orthodromic tachycardia with AV accessory pathways. 17,21,22 In one case in the group with accessory pathways, the unusual ECG during SVT was attributed to a morphological abnormality of the patient's chest. 17 Another case with negative concordance occurred in 2 pre-excited wide QRS complex (antidromic) tachycardias in a patient with a decrementally conducting atriofascicular accessory pathway (also known as a Mahaim connection).…”

“…17,21,22 In one case in the group with accessory pathways, the unusual ECG during SVT was attributed to a morphological abnormality of the patient's chest. 17 Another case with negative concordance occurred in 2 pre-excited wide QRS complex (antidromic) tachycardias in a patient with a decrementally conducting atriofascicular accessory pathway (also known as a Mahaim connection). 19 In these tachycardias, the anterograde activation began at the right atrial annulus, then it traveled along the bypass tract to its insertion in the distal part of the right bundle branch or the adjacent myocardium and then returned through either a fast or slow AV nodal retrograde limb.…”

Broad QRS complex tachycardias in the emergency department: a review of distinguishing features

“…According to Wellens, this is true since accessory pathways over which anterograde conduction leads to completely negative QRS complexes in all the leads do not exist (Wellens and Conover, 1992). However, a recent report of an 11year old male demonstrated that this 'rule' is not perfect, as his underlying pectus excavatum and SVT withLBBB resulted in a BCT with negative precordial concordance due to SVT with aberrant conduction (Volders et al, 2003). This observation led the authors to conclude that no diagnostic technique is perfect and that there are always exceptions to the rule and electrophysiology (Kappos et al, 2006).…”