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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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) ,.
  • Symptoms or signs indicating haemodynamic instability or cardiac compromise, such as syncope, chest pain, breathlessness, or heart failure ,.
  • History or family history of sudden cardiac death or inherited cardiac conditions .
  • New or unexplained symptoms during exertion or at rest that raise suspicion of a life-threatening arrhythmia .
  • Any suspicion of ACS based on clinical assessment and ECG findings, which requires immediate management and hospital transfer .

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

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