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A wide complex tachycardia is any tachycardia with a rate > 100 beats/minute and with a QRS width > 120 ms. Clinicians are often required to make an immediate and accurate diagnosis based on ECG tracings. An incorrect diagnosis may result in improper therapy and result in life-threatening outcomes. This inaugural article for the “ECG 101” section is designed to provide a simplified approach to accurately diagnose the cause of a wide complex tachycardia.

A recent report has described the use of electrograms (ECGs) stored in a pacemaker to help determine the probable cause of death.¹ The physician performing diagnostic and interventional catheterization procedures can utilize improvements in detection and storage of arrhythmias in permanent pacemakers to diagnose conditions such as unrecognized paroxysmal atrial fibrillation and ventricular tachycardia that may affect patient outcomes. This report provides two examples of the types of pacemaker electrograms encountered in clinical practice. The literature suggests that direct analysis of stored electrograms may be needed for diagnosis in some patients.

Since the time that the string galvanometer was introduced, the electrocardiogram (ECG) has been considered an essential cardiovascular diagnostic tool in clinical practices.^1,2 Despite technological advances, the most comprehensive updating of electrocardiographic standards and criteria dated from the mid 1970s.^3–7 The American Heart Association, with the endorsement of the American College of Cardiology, the Heart Rhythm Society, and the International Society for Computerized Electrocardiography, recently convened a writing group to produce a new series of scientific statements regarding the ECG. The goals of these statements are: 1) “to review the status of techniques currently used to record and interpret the ECG and to identify opportunities for modification”^8–10; 2) “to simplify and unify the various descriptive, diagnostic and modifying terminologies currently used in order to create a common and more easily applied lexicon”^8–10; and 3

When first diagnosed with a potentially life-threatening heart condition, a patient’s emotions can run the gamut: fear, denial, anger, depression. To make matters worse, if the disorder is an inherited, genetic condition, other family members — such as parents, siblings, and children — may also be at risk. If the disorder is rare, information may be difficult to find and awareness limited or non-existent. Friends, co-workers and teachers may ask, “What’s that? I’ve never heard of it!” The patient begins to feel quite alone at a time when they most need information and support. This is when a call or e-mail to an organization like the CARE Foundation can be a lifeline in a sea of confusion and concern.

Bobbi-Jean Plummer, CEN, CCRN, APRN, BC, who is a cardiac clinical nurse specialist, recently contributed an article on ECG interpretation for the June issue of the American Journal of Nursing. She is located at St. Joseph’s Regional Medical Center in Paterson, New Jersey.

In this article, the authors discuss the creation of the International Children’s Heart Foundation (ICHF) and the availability of humanitarian pediatric cardiac assistance around the world. Dr. Novick is the Founder and Medical Director of the ICHF.