Which statement best describes pulseless ventricular tachycardia on ECG?

Which statement best describes pulseless ventricular tachycardia on ECG?

• A. The rhythm is irregular with no discernible P waves, QRS, or T waves.
• B. P waves precede QRS complexes with normal duration.
• C. The ventricular rate is usually greater than 180 bpm and the QRS complexes are very wide.
• D. The rhythm is a regular, stable rhythm with narrow QRS.

Answer: (C)

Pulseless ventricular tachycardia on ECG shows a rapid, regular wide-complex tachycardia that originates in the ventricles. The key features are a very fast ventricular rate and QRS complexes that are wide (greater than about 0.12 seconds) because the impulse is not conducted through the normal His-Purkinje system. In ventricular tachycardia, there isn’t the typical atrial impulse preceding each QRS complex, since the rhythm is ventricular in origin. This combination—high rate and wide QRS—matches the description of a ventricular rate usually greater than 180 bpm with very wide QRS complexes. Other patterns described by the other options don’t fit pulseless VT. A rhythm with irregular, chaotic activity and no recognizable QRS corresponds more to ventricular fibrillation. A pattern with P waves before QRS and normal duration fits sinus rhythm. A regular, stable rhythm with a narrow QRS suggests a supraventricular tachycardia or sinus tachycardia. In ACLS, pulseless VT is a shockable rhythm requiring immediate defibrillation.

Pulseless ventricular tachycardia on ECG shows a rapid, regular wide-complex tachycardia that originates in the ventricles. The key features are a very fast ventricular rate and QRS complexes that are wide (greater than about 0.12 seconds) because the impulse is not conducted through the normal His-Purkinje system. In ventricular tachycardia, there isn’t the typical atrial impulse preceding each QRS complex, since the rhythm is ventricular in origin. This combination—high rate and wide QRS—matches the description of a ventricular rate usually greater than 180 bpm with very wide QRS complexes.

Other patterns described by the other options don’t fit pulseless VT. A rhythm with irregular, chaotic activity and no recognizable QRS corresponds more to ventricular fibrillation. A pattern with P waves before QRS and normal duration fits sinus rhythm. A regular, stable rhythm with a narrow QRS suggests a supraventricular tachycardia or sinus tachycardia. In ACLS, pulseless VT is a shockable rhythm requiring immediate defibrillation.