Category Archives: Latest News

How Long Does ACLS Certification Last?

Are you a healthcare professional currently wondering if your ACLS certification is still valid? Missing your renewal window can lead to stress, missed shifts, or even non-compliance in your workplace. That’s why it’s important to know how long ACLS certification lasts and what you need to do to renew it.
This blog will break down everything you need to know about when ACLS certification expires, including renewal tips to make the process smooth and stress-free.

What Is ACLS Certification?

ACLS stands for Advanced Cardiovascular Life Support. ACLS certification consists of a comprehensive course designed to teach healthcare professionals how to respond effectively to cardiac emergencies, such as cardiac arrest and stroke.

Once you have completed an online ACLS certification program, you will need to pass a written exam and a skills test in order to become certified. The written exam will test your knowledge of the ACLS guidelines, and the skills test will assess your ability to perform CPR and other lifesaving procedures.

ACLS certification is an important credential for healthcare professionals who work in emergency medicine. It demonstrates your commitment to providing high-quality care to patients in need.

How Long Is ACLS Good For?

ACLS certifications are valid for two years. After that, you will need to complete a recertification course to maintain your certification.  This ensures that you stay updated on the latest lifesaving techniques when responding to cardiac emergencies.

Please note that some employers may have specific requirements regarding ACLS certification expiration dates. It’s important to check with your employer or organization for their specific policies.

Why Does ACLS Certification Expire?

Like many other certifications, ACLS certification expires to ensure that healthcare professionals stay current with the latest advancements in cardiac care.

Here are the primary reasons for this:

  1. Evolving Medical Practices:
    • New guidelines and protocols: The field of medicine, particularly in emergency care, is constantly evolving. New research and clinical trials lead to updated guidelines and protocols for managing cardiac emergencies.
    • Technological advancements: New medical devices and techniques are introduced regularly, requiring healthcare providers to be proficient in their use.
  2. Maintaining Skill Proficiency:
    • Hands-on practice: Regular recertification courses provide opportunities for healthcare professionals to practice essential skills, such as intubation, defibrillation, and medication administration.
    • Skill decay: Without regular practice, skills can deteriorate, potentially impacting patient outcomes.
  3. Ensuring Patient Safety:
    • Competency assessment: Recertification processes help ensure that healthcare providers maintain the necessary knowledge and skills to provide high-quality care.
    • Risk mitigation: By requiring regular updates, certification bodies aim to minimize the risk of errors and adverse events.

By mandating periodic recertification, healthcare organizations and regulatory bodies work to uphold standards of excellence in patient care and public safety.

How to Check Your ACLS Certification Expiration Date

  1. Check Your Certification Card:
    • Look for the expiration date printed directly on your physical ACLS certification card.
  2. Contact Your Training Center:
    • If you’re unsure where you got your certification or can’t find your card, contact the training center where you completed the course. They can provide you with the expiration date.
  3. Check Online Portals (if applicable):
    • Some online certification platforms allow you to log in and view your certification details, including the expiration date.

Remember:

  • ACLS certifications typically last for two years.
  • It’s important to keep your certification valid to maintain your skills and eligibility to practice.
  • Plan ahead for recertification to avoid any lapses in your certification status.

By following these steps, you can easily keep track of your ACLS certification expiration date and make sure you’re always prepared to provide the best possible care.

What Happens if Your ACLS Certification Expires?

If your ACLS certification expires, you will no longer be authorized to perform advanced cardiac life support procedures. This could have serious consequences, both professionally and legally.

Here are just some of the potential consequences of having an expired ACLS certification:

  • Loss of Employment: Many healthcare facilities require their employees to maintain current ACLS certification as a condition of employment. If your certification expires, you may be subject to disciplinary action, including termination.
  • Inability to Practice: If you are a healthcare provider, such as a nurse or physician, you may be unable to practice in certain settings or perform certain procedures if your ACLS certification has expired.
  • Legal Liability: In the event of a medical emergency, if you attempt to provide advanced cardiac life support without a valid certification, you could be held liable for any harm that results from your actions.
  • Difficulty Obtaining Future Certifications: Some certification boards may require you to complete additional training or testing if your certification has expired for an extended period.

To avoid these consequences, make sure to renew your certification before it expires.

How to Renew Your ACLS Certification

To renew your ACLS certification, you’ll typically need to complete a recertification course. Here are the general steps involved:

  1. Check Your Expiration Date:
    • Confirm the exact expiration date on your current ACLS certification card.
  2. Enroll in a Recertification Course:
    • Look for a reputable training provider such as ACLS Medical Training and enroll in their recertification course.
  3. Complete the Course Requirements:
    • Online Learning Modules: Complete the required online modules at your own pace.
    • Skills Check-Off: Demonstrate your proficiency in essential ACLS skills, such as CPR, defibrillation, and medication administration.
    • Written Exam: Pass a written exam to assess your knowledge of ACLS guidelines and protocols.
  4. Receive Your New Certification Card:
    • Upon successful completion of the recertification course, you will receive a new ACLS certification card with a valid expiration date.

Can I Renew My ACLS Certification Online?

Yes, you can! With ACLS Medical Training, you can renew your ACLS certification right from the comfort of your own home. Our ACLS Recertification Course is 100% online and mobile-friendly. Your progress will be tracked and saved automatically, so you can learn at your own pace. You will be provided with an updated ACLS provider card once you finish the program.

What Topics Are Covered in an ACLS Renewal Course?

An ACLS renewal course is designed to refresh your knowledge and skills in advanced cardiac life support. Here’s a breakdown of what you’ll typically learn during one of these courses:

  • ACLS Algorithms: You’ll review the latest ACLS algorithms, which are step-by-step guidelines for managing cardiac arrest and other life-threatening arrhythmias.
  • Pharmacology: You’ll review the appropriate use of medications in cardiac emergencies, including dosage, administration routes, and potential side effects.
  • Electrocardiogram (ECG) Interpretation: You’ll practice identifying and interpreting various cardiac arrhythmias, such as ventricular tachycardia, ventricular fibrillation, and bradycardia.

Start Your Journey With ACLS Medical Training

Renewing your ACLS certification doesn’t have to be stressful. Whether you’re approaching your renewal date or getting certified for the first time, staying compliant ensures you’re always ready to save lives. Our online ACLS certification and recertification courses are designed to be convenient, comprehensive, and accessible. Enroll today and take the next step toward maintaining your lifesaving expertise!

What Is ACLS Certification?

Imagine this: a patient in cardiac arrest arrives at the emergency room, and the medical team leaps into action with precision and confidence. Behind this quick and effective response is training in Advanced Cardiovascular Life Support (ACLS). For healthcare professionals, ACLS certification is more than just a requirement—it’s a lifesaving tool that empowers them to handle critical emergencies with expertise.

In this blog, we’ll uncover what ACLS certification is, why it’s essential, and how you can achieve this vital credential.

ACLS Certification: What Is It?

If you’re wondering “What is an ACLS certification?”, you’re not alone. An ACLS certification stands for Advanced Cardiovascular Life Support certification. It is a qualification that healthcare professionals obtain to demonstrate their knowledge and skills in managing life-threatening cardiac emergencies. This certification is typically required for professionals working in emergency medical services, hospitals, and other healthcare settings where they may encounter patients experiencing cardiac arrest, heart attacks, strokes, or other serious heart-related conditions.

What Does ACLS Certification Cover?

ACLS certification helps prepare healthcare professionals to handle medical emergencies with confidence. The ACLS course covers a wide range of topics, including:

  • Basic life support (BLS): This includes CPR, use of an AED, and basic airway management.
  • Advanced cardiac life support: This covers more advanced techniques such as advanced airway management, medication administration, and defibrillation.
  • Recognition and management of cardiac arrest: This includes recognizing the signs and symptoms of cardiac arrest and initiating appropriate interventions.
  • Recognition and management of other life-threatening arrhythmias: This includes recognizing and treating other abnormal heart rhythms, such as ventricular tachycardia and ventricular fibrillation.
  • Recognition and management of acute coronary syndromes: This includes recognizing and treating heart attacks.
  • Recognition and management of stroke: This includes recognizing and treating strokes.

What Is ACLS Certification Used For?

ACLS certification is used to demonstrate a healthcare professional’s ability to manage life-threatening cardiac emergencies. It’s particularly important for those who work in settings where they may encounter patients experiencing:

  • Cardiac arrest: This is when the heart stops pumping blood effectively.
  • Heart attacks: This occurs when blood flow to the heart is blocked.
  • Strokes: This happens when blood flow to the brain is interrupted.
  • Other serious heart-related conditions

What Is ACLS Certification for Nurses?

There actually isn’t a specific ACLS certification tailored exclusively for nurses. The ACLS certification is a standardized course designed for a wide range of healthcare professionals, including nurses, physicians, paramedics, and other medical personnel.
The curriculum and skills tested in the ACLS certification are the same regardless of the specific profession of the individual taking the course. This ensures that all healthcare providers are equipped with the necessary knowledge and skills to respond effectively to life-threatening cardiac emergencies.

Who Should Get ACLS Certified?

Healthcare professionals who frequently encounter life-threatening cardiac emergencies should consider getting ACLS certified. This includes:

  • Emergency Medical Services (EMS) personnel:
    • Paramedics
    • Emergency Medical Technicians (EMTs)
  • Hospital-based healthcare providers:
    • Emergency Department physicians and nurses
    • Intensive Care Unit (ICU) physicians and nurses
    • Critical Care nurses
    • Anesthesiologists
    • Respiratory therapists

Essentially, anyone who may be responsible for initiating advanced cardiac life support during a cardiac arrest or other life-threatening arrhythmia should be ACLS certified.
Remember, while ACLS certification is crucial for these professionals, it’s not limited to them. Other healthcare providers, such as physician assistants, nurse practitioners, and dentists, may also benefit from ACLS certification, especially if they work in settings where they may encounter cardiac emergencies.
The decision to pursue ACLS certification often depends on individual job requirements, state regulations, and institutional policies.

What’s The Difference Between BLS and ACLS?

BLS and ACLS are both vital certifications in emergency medical care, but they differ significantly in their scope and complexity. BLS focuses on fundamental life-saving techniques such as CPR and AED use, making it accessible to a wide range of individuals, including laypeople. ACLS, on the other hand, builds upon BLS by providing advanced skills for managing complex cardiac emergencies. It’s designed primarily for healthcare professionals like physicians, nurses, and paramedics, equipping them with techniques like advanced airway management, medication administration, and defibrillation. While BLS provides the initial response to a cardiac arrest, ACLS offers the advanced interventions necessary to improve patient outcomes in critical situations.

How Do You Get ACLS Certified?

To obtain an ACLS certification, you typically need to follow these steps:

  1. Find an Accredited Course Provider: Look for organizations accredited by recognized bodies like the American Heart Association (AHA) or the American Red Cross. These providers offer both in-person and online courses.
  2. Complete the Course: The course covers a range of topics, including advanced cardiac life support, recognition and management of cardiac arrest, acute coronary syndromes, and stroke. It often involves a combination of online learning modules and in-person skills sessions.
  3. Pass the Written Exam: Once you’ve completed the course materials, you’ll need to pass a written exam. This exam assesses your understanding of the theoretical concepts.
  4. Pass the Skills Test: You’ll also need to demonstrate your practical skills in a hands-on skills session. This typically involves scenarios simulating real-life emergency situations.
  5. Receive Certification: Upon successful completion of the course, written exam, and skills test, you’ll receive your ACLS certification.

How Long Is ACLS Certification Good For?

ACLS certification is typically valid for two years. After this period, healthcare professionals are required to complete a recertification course to maintain their credentials and ensure their skills remain current with the latest guidelines and protocols. Recertification often involves a review of key concepts, updated techniques, and passing a written and skills-based exam. Staying up to date with ACLS certification is essential for continuing to provide high-quality care in emergency situations.

Get ACLS Training Today

Ready to take your emergency response skills to the next level? ACLS certification not only equips you with the expertise to save lives during critical situations but also ensures you meet industry standards and employer requirements. Whether you’re a nurse, paramedic, or other healthcare professional, earning your ACLS certification is a vital step in advancing your career. With our flexible online ACLS courses, you can train at your own pace while receiving top-quality instruction from accredited providers. Don’t wait—enroll today and gain the confidence and skills needed to make a real difference when it matters most!

How Long Does BLS Certification Last?

Are you a healthcare professional looking to refresh your Basic Life Support (BLS) certification? Or perhaps you’re a new healthcare worker wondering how long your initial certification will last. Understanding the expiration date of your BLS certification is crucial to maintaining your professional credentials and ensuring you’re prepared to respond to medical emergencies. In this blog post, we’ll delve into the specifics of BLS expiration and renewal so you can stay current with your certification and avoid the hassle of dealing with an expired BLS provider card.

What Is BLS Certification?

Basic Life Support (BLS) certification is a credential for individuals trained in essential lifesaving techniques, such as CPR, using an AED (Automated External Defibrillator), and aiding individuals experiencing choking or cardiac arrest. BLS is primarily geared towards healthcare professionals but is also beneficial for individuals in emergency response roles. This certification ensures that participants can respond effectively in critical situations.

How Long Is BLS Good For?

BLS certifications are typically valid for two years. This means that after two years, you’ll need to renew your certification by taking a recertification course. This ensures that you stay up-to-date on the latest CPR and first aid techniques.

It’s important to note that some employers may have specific requirements regarding BLS certification expiration dates, so it’s always a good idea to check with your employer for their specific policies.

Why Does BLS Certification Expire?

Staying up-to-date on the latest techniques and guidelines in BLS is essential for several key reasons, such as:

  • Improved Patient Outcomes: Advances in medical research and technology continually refine lifesaving techniques. Staying updated ensures you’re using the most effective methods to improve survival rates during emergencies like cardiac arrest or choking.
  • Compliance with Industry Standards: Healthcare organizations and accrediting bodies regularly update their guidelines based on the latest evidence. Staying current helps you meet professional and regulatory requirements, ensuring you remain compliant in your role.
  • Increased Confidence and Competence: Regular updates reinforce your skills, keeping you confident and prepared to respond effectively in high-stress situations. This readiness can make a significant difference in saving lives.
  • Adapting to New Tools and Techniques: BLS guidelines often include updates about new equipment or practices, such as improvements in Automated External Defibrillator (AED) usage or changes in CPR techniques. Being up-to-date ensures you’re familiar with these innovations.
  • Maintaining Credibility: As a professional, your ability to provide top-quality care reflects on your credibility. Employers, patients, and peers trust those who prioritize staying informed and capable.
  • Legal and Ethical Responsibility: Providing care with outdated knowledge may lead to preventable errors. Staying current fulfills your ethical obligation to provide the best possible care and minimizes legal risks.

How to Check Your BLS Certification Expiration Date

Checking your certification expiration date is easy! Simply:

  1. Review the certification card issued by the organization (e.g., ACLS Medical Training, American Heart Association, or Red Cross).
  2. Log into the issuing organization’s website or app if they offer online account access.
  3. Contact the training provider where you completed the course for confirmation.

What Happens if Your BLS Certification Expires?

If your BLS certification expires, you may:

  • Need to retake the full course rather than just a renewal.
  • Risk being non-compliant with job requirements, particularly in healthcare roles.
    To avoid lapses, schedule your renewal before your certification’s expiration date.

How to Renew Your BLS Certification

Renewing your BLS certification involves:

  1. Enrolling in a BLS renewal course through an accredited provider such as ACLS Medical Training.
  2. Completing the course, which typically takes a few hours and may include online and hands-on components.
  3. Passing a skills assessment to demonstrate your proficiency.
    Some organizations also offer streamlined online renewal options for qualified participants.

Tips to Stay Current with Your BLS Certification

To ensure you’re always prepared to respond to emergencies, consider implementing these tips to stay current with your BLS certification:

  • Set Reminders: Use a calendar or digital reminder app to mark your certification expiration date.
  • Enroll in a Renewal Course Early: Don’t wait until the last minute to renew your certification.
  • Practice Regularly: Practice CPR and other BLS skills regularly to stay proficient.
  • Attend Refresher Courses: Consider attending additional training courses to enhance your skills.
  • Check with Your Employer: Some employers may have specific requirements for BLS certification, so be sure to check with them.
    By following these tips, you can ensure that your BLS certification remains current and that you’re prepared to respond to emergencies effectively.

Can I Renew My BLS Certification Online?

Yes, you can renew your BLS certification online. Many organizations, such as ACLS Medical Training, offer a completely online and mobile-friendly BLS recertification course. Our course is self-paced for your convenience, meaning your progress will be saved as you take it. Upon successfully completing the program, you will receive a BLS provider card, which is accepted in all 50 states and abroad.

What Happens During a BLS Renewal Course?

A BLS renewal course, whether online or in-person, typically involves the following:

  1. Review of BLS Guidelines: You’ll review the latest guidelines for CPR, AED use, and choking relief.
  2. Skill Demonstration: You’ll practice these skills under the supervision of an instructor. This may involve practicing on mannequins or other training aids.
  3. Written Exam: You’ll take a written exam to test your knowledge of BLS principles and guidelines.

The specific content and format of the course may vary depending on the certifying organization and the type of course you choose. However, the core components will remain consistent.

Get Started With ACLS Medical Training Today

Basic Life Support (BLS) certification is an essential tool for anyone, from healthcare professionals to everyday citizens, who may encounter a life-threatening emergency. By understanding the importance of BLS, its components, and its expiration, you can ensure that you’re prepared to respond effectively in a critical moment.
Don’t let your skills lapse! Choose ACLS Medical Training for your BLS needs. Head to our website to enroll in our online BLS course today to maintain your certification and refresh your knowledge. Our BLS certification course is 100% online and all study materials are included with purchase. You will also receive a BLS provider card once you pass your final exam. Get started today!

Guide to Understanding ECG Artifact

An electrocardiogram (ECG) is a cornerstone of cardiac diagnosis, providing invaluable insights into the heart’s electrical activity. However, the accuracy of ECG interpretation can be significantly compromised by artifact, which represents any extraneous electrical activity that interferes with the underlying cardiac signal. This guide offers a comprehensive overview of common ECG artifacts, their causes, and strategies for mitigation, aiming to enhance the reliability of ECG interpretation and improve patient care.

Types of ECG Artifacts

Artifacts on the electrocardiogram can result from a variety of internal and external causes, from Parkinsonian muscle tremors to dry electrode gel.

Most of the time it will be obvious that you are dealing with artifact on ECG issues and troubleshooting the problem will be straight forward. However, there are occasions when artifact mimics ECG abnormalities that can cause problems for patient care.

In one instance, a cardiac monitoring technician responded to an alarm indicating potential ventricular tachycardia. Upon arriving at the patient’s room, it was discovered that the patient was simply brushing their teeth, causing an artifact that mimicked the dangerous arrhythmia. With a trained eye, you can often learn to spot the underlying rhythm “marching” through this type of artifact. Other times, it’s not that easy.

Here are some types of artifacts you may encounter, along with some tips to help you achieve excellent data quality on your ECG tracings.

Loose Lead Artifact

You will frequently encounter loose lead artifact when dealing with patients who are diaphoretic because the electrodes simply will not stick to the patient’s body. You may also see this type of artifact when placing the electrode over hair.

To troubleshoot this problem, make sure you prep the skin carefully! Consider the tincture of benzoin. It works great for diaphoretic patients. However, tincture of benzoin is flammable! You don’t want to use it for defibrillation pads.

In this example, loose lead artifacts can be seen in leads I and II.

Loose lead artifact

What electrodes do leads I and II have in common?

  • Lead I is a dipole with the negative electrode on the right arm and the positive electrode on the left arm.
  • Lead II is a dipole with the negative lead on the right arm and the positive electrode on the left leg.

Lead I and lead II share the right arm electrode! That is the electrode that is causing this problem.

Wandering Baseline Artifact

Wandering baseline artifact presents as a slow, undulating baseline on the electrocardiogram. It can be caused by patient movement, including breathing.

Wandering baseline artifact

Stopping or accelerating the ambulance can also cause a wandering baseline ECG. Some references suggest that wandering baseline can be caused by loose or dry electrodes. Some paramedics ask patients to hold their breath while they capture a 12-lead ECG. Be aware that this can also alter the patient’s heart rate.

There are times when your patient is acutely short of breath, and it’s simply impossible to capture a 12-lead ECG with excellent data quality.

Muscle Tremor Artifact

Muscle tremor (or tension) artifact is a type of motion artifact. Usually, it’s happening because your patient is cold and shivering. However, it can also happen when patients prop themselves up with their arms.

The example below was obtained from a young, healthy firefighter during routine training. It was cold in the fire station, and he was shivering.

12-Lead 1

The next example was taken after a large towel was placed over the firefighter. It made quite a difference, didn’t it?

12-Lead 2

Electromagnetic Interference (EMI)

Electromagnetic interference (EMI) artifact usually results from electrical power lines, electrical equipment, and mobile telephones. In the United States this is sometimes referred to as 60 cycle interference (or 60 Hz pickup).

Electromagnetic interference (EMI)

Creative Commons: ECGGuru.com

To help minimize 60 cycle interference you can set the diagnostic mode of your 12-lead ECG monitor to 0.05 – 40 Hz. As long as the low frequency / high pass filter (the lower number) is set to 0.05 Hz you should get accurate ST-segments.

CPR Compression Artifact

This ECG was automatically recorded during a cardiac arrest.

Preshock and Postshock

The wavy line after the shock is CPR artifact. Using the small block method (1500/13=115) we can determine that the compression rate was about 115/min. which is perfect! There may be times when CPR artifact makes it difficult to determine the underlying rhythm. However, if you’re performing CPR at a 30:2 compression to ventilation ratio you can see the underlying rhythm during ventilations.

Neuromodulation Artifact

Here’s a type of artifact that is starting to be seen more frequently as implantable neurostimulators become more prevalent.

These devices are used to treat a variety of symptoms, including tremors, seizures, chronic pain, nausea and vomiting related to gastroparesis, problems with bladder or bowel control, visual impairment, and hypertension.

EKG artifact

If you see an artifact that looks like this, you should ask your patient if he or she has any implantable medical devices. Some devices can be temporarily turned off with a magnet, but you should consult with the prescribing physician.

Echo Distortion Artifact

This type of artifact is associated with transcutaneous pacing (TCP). Echo distortion causes a pseudo-QRS complex after the pacing spike, which is sometimes referred to as “false capture.”

Pacing 5 Changed

The pacing spike is a graphical representation that an electrical current is about to pass between the pacing pads. It is followed by a short “blanking period” of about 40 ms (one small block) where the monitor essentially “closes its eyes”. If it did not, the signal would go right off the ECG paper!

After the blanking period the monitor “opens its eyes” to see the QRS complex that is created by the pacing stimulus. However, sometimes the monitor catches the pacing current as it returns to baseline causing a pseudo-QRS complex on the ECG. You can read more about the problem of false capture here.

Arterial Pulse Tapping Artifact

This unusual artifact causes large, bizarre T-waves on the ECG. The phenomenon was first reported in 2005 by Özhan et al. as a “bizarre electrocardiogram” thought to be associated with abnormal left ventricular motion.

Subsequent work by Aslanger solved the issue in favor of arterial pulse tapping (which explains why the artifact occurs synchronously with the cardiac cycle on the ECG.)

Consider these two ECGs which were recorded from the same patient less than 1 minute apart. The first ECG shows simple motion artifact in leads I, III, and aVL.

Simple motion artifact

Courtesy of Frank Intessimoni (@njmedic3228)

The second ECG shows large, bizarre T-waves that were concerning to the paramedics on the call.

Bizarre T-waves

Courtesy of Frank Intessimoni (@njmedic3228)

You will note that the artifact is most pronounced in leads I, II, and aVR. Lead III appears perfectly normal. This suggests that the right arm electrode was placed over the radial artery.
But if that’s true, why is there also an artifact in other leads?

Aslanger explains:

“[O]ne may expect that the leads not connected to the electrode affected by the source of disturbance would be free of distortion, but this is not the case. When one of the limb electrodes is affected by a source of disturbance, it distorts not only the corresponding derivation but also [the others], which are all calculated by mathematical equations…”

“…precordial leads [are also affected] because the Wilson central terminal, which constitutes the negative pole of the unipolar leads, is produced by connecting 3 limb electrodes via a simple, resistive network to give an average potential across the body.”

Get Started With ACLS Certification Training

By understanding common artifacts and their potential impact on diagnosis, healthcare providers can significantly improve their ability to accurately assess cardiac conditions. While recognizing artifacts can be challenging, consistent practice and advanced training are invaluable. To further enhance your ECG interpretation skills and prepare for critical cardiac emergencies, consider enrolling in our online ACLS Certification Training course. Our comprehensive curriculum covers advanced cardiac life support, including in-depth ECG analysis, to teach you everything you need to know to handle high-pressure situations effectively. Take the next step in your professional development and enroll today!

References

Aslanger E, Yalin K. Electromechanical association: a subtle electrocardiogram artifact. Journal of Electrocardiology. 2012;45(1):15-17. doi:10.1016/j.jelectrocard.2010.12.162.

Aslanger E, Bjerregaard P. Mystery of “bizarre electrocardiogram” solved. Journal of Electrocardiology. 2011;44(6):810-811. doi:10.1016/j.jelectrocard.2011.04.001.

SVT with Aberrancy or Ventricular Tachycardia?

Differentiating between SVT with aberrancy and ventricular tachycardia (VT) can be a challenging task, even for experienced healthcare providers. This blog aims to clarify the distinction between these two cardiac arrhythmias, emphasizing the potential dangers of misdiagnosis and the importance of accurate identification. By understanding the concepts of aberrant conduction and the characteristics of SVT and VT, healthcare professionals can improve patient care and outcomes.

What Is SVT With Aberrancy?

The term “SVT with aberrancy” tends to throw many providers off, so let’s start by defining SVT using the 2015 ACC/AHA/HRS Guidelines as a reference.

“An umbrella term used to describe tachycardias (atrial and/or ventricular rates in excess of 100 bpm at rest), the mechanism of which involves tissue from the His bundle or above. These SVTs include inappropriate sinus tachycardia, AT (including focal and multifocal AT), macroreentrant AT (including typical atrial flutter), junctional tachycardia, AVNRT, and various forms of accessory pathway-mediated reentrant tachycardias. In this guideline, the term does not include AF.”

This is important because many of us were taught a narrow, complex rhythm: “must be SVT if the rate is over 150,” which can lead to inappropriate therapies. In reality, sinus tachycardia is a form of SVT, and the rate can easily exceed 150. A good rule of thumb to estimate the maximum sinus rate is 220 minus age, but that can vary by 10-15%, which is a lot.

What most people really mean when they call a rhythm “SVT” is AV Nodal Reentrant Tachycardia or AVNRT, which is a reentrant rhythm in or around the AV node. This arrhythmia is usually stable, and the prognosis is much more favorable than that of VT. It is usually treated with vagal maneuvers or adenosine.

What Does Aberrancy Mean?

You can think of “aberrancy” as abnormal conduction. When something is aberrant, it “departs from the right, normal, or usual course.”

Because the right bundle branch tends to have a slightly longer refractory period than the left bundle branch, at higher rates the right bundle branch may not be fully recovered from the previous cardiac cycle, which results in a right bundle branch block pattern.

Even though right bundle branch block aberrancy is more common than left bundle branch block aberrancy, both are possible. Additionally, we know that many patients have underlying bundle branch block, including bifascicular block, at baseline.

When a patient with a bundle branch block experiences SVT, the result is a wide complex tachycardia.

Is Aberrant Conduction Dangerous?

While aberrant conduction itself is not inherently dangerous, the potential for misdiagnosis is a significant concern. Mistaking SVT with aberrancy for VT can lead to the administration of antiarrhythmic medications or cardioversion, which can be harmful if the underlying rhythm is SVT.

SVT With Aberrancy vs. VT

Differentiating between SVT with aberrancy and VT can help determine the appropriate treatment. Several factors can help distinguish between the two, including the patient’s clinical presentation, the appearance of the ECG, and the response to specific medications. While there are diagnostic criteria to help rule in VT, there are currently no definitive criteria to safely rule out VT.

It is important to approach wide complex tachycardias with caution and to consider the possibility of both SVT with aberrancy and VT. Obtaining a 12-lead ECG before and after treatment can aid in diagnosis. In cases of unstable wide complex tachycardia, immediate synchronized cardioversion is often necessary.

Can You Differentiate Between SVT With Aberrant Conduction and VT?

The short answer is yes, but it can be very difficult, and even experienced clinicians can misdiagnose VT as SVT with aberrancy!

This can lead to clinical misadventure. In particular, treating a wide complex tachycardia with a calcium channel blocker is a dangerous decision that could have fatal consequences for your patient.

There are good criteria to help rule-in, or tip the scales in favor of VT, but none to safely rule-out VT.

See also: Myths and Cognitive Biases in Interpretation of Wide Complex Tachycardias

Consider the following case:

EMS is dispatched to an 83-year-old female who contacts 9-1-1 after she wakes up with a “racing heart” and shortness of breath.

Past medical history includes myocardial infarction and hypertension.

On initial assessment the patient is found to be alert and oriented to person, place, time, and event. The skin is pale but warm and dry. Radial pulses are very rapid but surprisingly strong. Breath sounds are clear bilaterally.

She is placed on the cardiac monitor, and the following rhythm strip is obtained.

regular complex tachycardia at a rate of ~ 230 bpm

Figure 1: There is a wide and regular complex tachycardia at a rate of ~ 230 bpm.

The patient is placed on oxygen via nasal cannula, and IV access is established while vital signs are obtained.

  • RR: 24
  • HR: Too fast to count
  • NIBP: 112/72
  • SpO2: 97%
  • Temp: 98.3 F / 36.8 C

Why should you presume that this rhythm is ventricular tachycardia?

  • VT accounts for 80% of all cases of WCT
  • If the patient has a previous cardiac history, the predictive value can go up over 90%
  • An age greater than 35 years has a sensitivity of 92%

Treatment

A 12 lead ECG is obtained.

Figure 2: There is a regular wide complex tachycardia at a rate of about 230 without sinus P waves. There is a LBBB pattern in lead V1. However, we would not consider this to be a “typical” LBBB pattern due to the normal axis in the frontal plane and the presence of a small S-wave in lead I.

Amiodarone 150 mg is given over 10 minutes.
A rhythm change is noted, and the following 12-lead ECG is obtained.

Figure 3: Now there is sinus tachycardia with virtually identical QRS morphology.

Once the patient converts to sinus tachycardia (and after a sigh of relief), paramedics compare the two 12-lead ECGs. The axis and QRS morphology are noted to be exactly the same.
The diagnosis? SVT with aberrancy!

It is safe to conclude that this patient had a conduction defect at baseline, which is what caused the complexes to be wide during the tachycardia.

Retrospectively, adenosine would have been safe and likely effective. In many cases, it can be considered as a first line therapy for undifferentiated wide complex tachycardia, and may have some diagnostic utility when considered in the context of other findings.

Take the Next Step in Cardiac Care With ACLS Medical Training

Accurately differentiating between SVT with aberrancy and ventricular tachycardia is crucial for effective and safe patient care. Misdiagnosis can have severe consequences. By understanding the key characteristics of each arrhythmia and utilizing appropriate diagnostic tools, healthcare providers can improve their ability to recognize and manage these complex cardiac conditions.

To further enhance your knowledge and skills in advanced cardiac life support, consider enrolling in our online ACLS certification course. By investing in your ACLS certification, you’ll be better equipped to handle a wide range of cardiac emergencies and provide optimal care for your patients. Head to our website to get started today!

References

Alzand BCrijns H. Diagnostic criteria of broad QRS complex tachycardia: decades of evolution. Europace. 2010;13(4):465-472

Neumar R, Otto C, Link M et al. Part 8: Adult Advanced Cardiovascular Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18_suppl_3):S729-S767