A 60-year-old man presents with palpitations. ECG shows a regular wide-complex tachycardia at 180 bpm. He is hemodynamically stable with BP 120/80 mmHg. Which single ECG finding most strongly supports a diagnosis of ventricular tachycardia over SVT with aberrancy?

• A QRS duration >140 ms
• B Left axis deviation
• C Heart rate >150 bpm
• D RS interval >100 ms in any precordial lead ✓

Explanation

The Brugada criteria for VT include RS interval >100 ms in any precordial lead, which has high specificity for VT. QRS >140 ms favors VT but is less specific. Heart rate is not discriminating. Left axis deviation can occur in both. When stable, the Brugada algorithm should be applied before treatment, as incorrect diagnosis leads to inappropriate therapy.

Reference: Braunwald's Heart Disease, 12th ed.

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