ECG Broad complex tachycardia

A 40 years old male, K/C/O  Bicuspid aortic valve with severe aortic stenosis with S/P DDD pacemaker ( For syncope due to trifascicular block with prolonged HIS- ventricular interval ) comes to JIPMER emergency with history of acute onset palpitation since last two hours. During the time of admission his pulse rate was 190/min, BP 100/80 mmhg, chest was bilateral clear, there was no crepitation. ECG done in the emegency department is shown below

ECG 1

ECG 2

ECG 3

What is your diagnosis?

Description of the ECG- Broad complex regular tachycardia at around 200 beats per minute,right axis deviation,QRS duration around 280 msec, RBBB morphology, no P wave, no capture wave, no fusion beat.

Diagnosis-Broad complex tachycardia, Differential diagnosis- Ventricular tachycardia, Or It could be Supraventricular tachycardia with aberrancy

Unfortunately baseline ECG was not available for this patient. ECG has criteria which favor both a diagnosis of VT and SVT, so definite diagnosis not possible.  Only differential diagnosis can be given.

Approach in a patient with Broad complex tachycardia
Please do not try to jump to  make a diagnosis of any ecg, first step,  is to describe the ECG in detail, than try to give broad diagnosis and than give your differential diagnosis.

See diagram below how to approach a patient with Broad complex tachycardia

Other algorithm which can be used in a patient with  broad complex tachycardia