What criteria should I use to determine whether a patient with broad complex tachycardia requires urgent referral to secondary care?

Criteria for urgent referral of a patient with broad complex tachycardia to secondary care include:

• Presence of any ECG abnormalities suggestive of serious cardiac pathology, such as conduction abnormalities (including bundle branch block), ventricular arrhythmias, or signs consistent with acute coronary syndrome (ACS) ¹,².
• Symptoms or signs indicating haemodynamic instability or cardiac compromise, such as syncope, chest pain, breathlessness, or heart failure ¹,².
• History or family history of sudden cardiac death or inherited cardiac conditions ¹.
• New or unexplained symptoms during exertion or at rest that raise suspicion of a life-threatening arrhythmia ¹.
• Any suspicion of ACS based on clinical assessment and ECG findings, which requires immediate management and hospital transfer ².

Patients meeting these criteria should be referred urgently for specialist cardiovascular assessment, ideally within 24 hours, or immediately if unstable ¹,².