Wide complex tachycardia run on event monitor

I posted on here a few months ago with concerns over my loop monitor report findings of PACs, PVCs, PJCs, atrial run, atrial couplets, ventricular triplet, sinus tach.  

I had a second month recorded and with the same findings, but also reported was a 6 beat run of wide complex tachcardia.  When this occurs I feel very faint, my vision dims, I feel weak and cold.  I feel this arrhythmia apprx 2 times a month.

1.)  Is this wide complex tach also the same as wide complex v-tach?

2.)  Is there anything systemically that could explain the arrhythmias and numerous ectopies?  I have had elevated ANA titres of 1:1280 and 1:640 for the past three years.  

3.)  Is there any true positive studies regarding pharmacological management with beta blockers or calcium channel blockers?

4.)  Echo showed a structurally normal heart, does a regualr echo show everything or is there any specialized thing to look for?

5.)  What would happen in the event of this wide complex tachycardia, poss v-tach, is not converted?

6.)  Can I send a copy of the strip for review as to what is this wide complex tach?

THhank you in advance for your response

[Michael J. McWilliams, M.D.]

1.)  Is this wide complex tach also the same as wide complex v-tach?

Not always.  Fast heart rhythms from the upper chambers can sometimes stress the conduction system and cause wide complexes.

2.)  Is there anything systemically that could explain the arrhythmias and numerous ectopies?  I have had elevated ANA titres of 1:1280 and 1:640 for the past three years.

Figuring out the physiologic reason will be very hard.  It probably has something to do with genetics, but don't have good genetic tests to determine the causes yet.  Lupus has been shown to be associated with cardiomyopathies but I have not read that it causes arrhythmias in the setting of a normal heart.
  

3.)  Is there any true positive studies regarding pharmacological management with beta blockers or calcium channel blockers?

The data shows in the setting of a structurally normal heart, there are no significant risk from these rhythms.  the beta blockers or CCB may decrease the symptoms but do no improve outcomes -- you can't improve outcomes if there are no or very few bad outcomes.

4.)  Echo showed a structurally normal heart, does a regualr echo show everything or is there any specialized thing to look for?

Sometimes MRIs can show scarring not seen on echo's but these are rarely done unless there is significant concern that something is being missed.

5.)  What would happen in the event of this wide complex tachycardia, poss v-tach, is not converted?

An EP study is done to determine what the mechanism is.  You are talking about very very very rare circumstances though.  I would not focus on this or you will drive yourself nuts.

6.)  Can I send a copy of the strip for review as to what is this wide complex tach?

You often can't tell for sure what the rhythm is from looking at the strips, sometimes you can.  I can't really review them hear for medical / legal reasons.  It is ok for me to answer questions but my health insurance company was a bit nervous about me reviewing strips and EKGs.  Sorry.  In an ideal world it would be nice.

I hope this helps.