Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia.

Publication/Presentation Date

3-1-2007

Abstract

AIMS: The Brugada criteria proposed to distinguish between regular, monomorphic wide QRS complex tachycardias (WCT) caused by supraventricular (SVT) and ventricular tachycardia (VT) have been reported to have a better sensitivity and specificity than the traditional criteria. By incorporating two new criteria, a new, simplified algorithm was devised and compared with the Brugada criteria.

METHODS AND RESULTS: A total of 453 WCTs (331 VTs, 105 SVTs, 17 pre-excited tachycardias) from 287 consecutive patients with a proven electrophysiological (EP) diagnosis were prospectively analysed by two of the authors blinded to the EP diagnosis. The following criteria were analysed: (i) presence of AV dissociation; (ii) presence of an initial R wave in lead aVR; (iii) whether the morphology of the WCT correspond to bundle branch or fascicular block; (iv) estimation of initial (v(i)) and terminal (v(t)) ventricular activation velocity ratio (v(i)/v(t)) by measuring the voltage change on the ECG tracing during the initial 40 ms (v(i)) and the terminal 40 ms (v(t)) of the same bi- or multiphasic QRS complex. A v(i)/v(t) >1 was suggestive of SVT and a v(i)/v(t)

CONCLUSION: The new algorithm is a highly accurate tool for correctly diagnosing the cause of WCT ECGs.

Volume

28

Issue

5

First Page

589

Last Page

600

ISSN

0195-668X

Disciplines

Medicine and Health Sciences

PubMedID

17272358

Department(s)

Department of Medicine

Document Type

Article

Link to Full Text

Share

COinS