Wide Complex Tachycardia in the Emergency Department: An Updated Approach to Diagnosis and Management (Pharmacology CME)

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Delivery Method:	Online
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Publication Date: April 2026 (Volume 28, Number 4)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 04/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 2 Pharmacology credits, subject to your state and institutional approval.

Authors

Abstract

Wide complex tachycardia encompasses a range of cardiac tachydysrhythmias, several of which can be life-threatening, difficult to distinguish, and require distinct treatment approaches. This review summarizes the etiologies and pathophysiology of wide complex tachycardia, outlines the differential diagnosis, and provides an evidence-based approach to distinguishing the various types using the history, physical examination, electrocardiography, and response to intravenous adenosine. Management strategies and disposition decisions are also reviewed, with attention to special clinical circumstances and selected areas of ongoing controversy, including emerging artificial intelligence tools.

Case Presentations

A 72-year-old man presents to the emergency department with shortness of breath…

• He is attached to the monitor and you see a wide complex tachycardia at a rate of 158 beats/min.
• His blood pressure is 128/73 mm Hg, and his pulse oximetry is 96% on ambient air.
• The patient sees you looking at the defibrillator and says, “I don’t want to be shocked. Are there any meds you can give me?”
• You consider which medications you should use for pharmacologic cardioversion of his ventricular tachycardia…

A 28-year-old woman presents to the emergency department with vomiting…

• She is treated with multiple rounds of antiemetics. As she is being prepared for transfer to the observation unit due to persistent oral intolerance, a nurse suddenly calls out for assistance.
• You arrive and check the monitor, where you see that the patient has a wide complex tachycardia with variable QRS morphology. You diagnose her with polymorphic ventricular tachycardia.
• She has a pulse. Her blood pressure is 60/30 mm Hg.
• As the nurses reach for pads to apply to the patient, you consider whether you need to synchronize the shock or defibrillate…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.