Which leads are most helpful in differentiating ventricular tachycardia (VT) from a supraventricular tachycardia (SVT) with aberrancy?

The most helpful leads in differentiating ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrancy are indeed V1 and V6. These leads provide critical views of the heart’s electrical activity from different spatial angles.

In particular, V1 is positioned in the right precordial area, which provides insight into the right ventricular depolarization and is especially useful for identifying the presence of a right bundle branch block (RBBB), which can occur during SVT with aberrancy. On the other hand, V6, located in the left lateral precordial area, helps in visualizing left ventricular depolarization and can also indicate the presence of a left bundle branch block (LBBB).

When evaluating the morphology of the QRS complexes in these specific leads, experienced clinicians can discern characteristics that suggest whether the rhythm is originating from the ventricles (VT) versus a problem with atrial conduction (SVT) when aberrant conduction is present. Generally, VT tends to show more uniform, wide complexes and a range of other diagnostic features that can be more easily distinguished in these leads compared to other options.

Thus, V1 and V6 provide complementary information essential for making the