This wide complex tachycardia occurred in a 91 year old man with a history of atrial fibrillation. He complained of "fluttering" in his chest, and denied chest pain or other problems. While the paramedic attempted to start an I.V., he spontaneously converted to atrial fibrillation with left BBB, and PVCs. Once he converted, his symptoms abated. Remember, all wide complex tachycardias (WCT) should be treated as V Tach in the field, as this is by far the most common WTC and the most dangerous.
Some of the ECG clues that this WTC is ventricular tachycardia are:
* Monophasic upright QRS in V1 (does not have RBBB pattern of rsR')
* Extreme left axis deviation (II, III, and aVF are negative, I, aVL, and aVR are poisitive)
* V6 is negative
For a more thorough discussion of the ECG signs of V Tach, go to Jason Roediger's Ask the Expert page discussion on the topic: