“Wide Complex Tachycardia: SVT With Aberrant Conduction or VT?”

At least a half-dozen times per year, an acute care physician sends me an ECG demonstrating a regular monomorphic wide complex tachycardia (WCT), asking me for my thoughts about the diagnosis. The backstory is almost always the same: The physician assumed that the WCT was a supraventricular tachycardia with aberrant conduction (SVT-AC) and treated it as such. The patient had a poor outcome because the diagnosis should have been ventricular tachycardia (VT). Consequently, the physician is criticized for poor decision-making and then sends me the case, hoping I will support their decision-making.