New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia

András Vereckei, Gábor Duray, Gábor Szénási, Gregory T. Altemose, John Miller

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

Background: We recently reported an ECG algorithm for differential diagnosis of regular wide QRS complex tachycardias that was superior to the Brugada algorithm. Objective: The purpose of this study was to further simplify the algorithm by omitting the complicated morphologic criteria and restricting the analysis to lead aVR. Methods: In this study, 483 wide QRS complex tachycardias [351 ventricular tachycardias (VTs), 112 supraventricular tachycardias (SVTs), 20 preexcited tachycardias] from 313 patients with proven diagnoses were prospectively analyzed by two of the authors blinded to the diagnosis. Lead aVR was analyzed for (1) presence of an initial R wave, (2) width of an initial r or q wave >40 ms, (3) notching on the initial downstroke of a predominantly negative QRS complex, and (4) ventricular activation-velocity ratio (vi/vt), the vertical excursion (in millivolts) recorded during the initial (vi) and terminal (vt) 40 ms of the QRS complex. When any of criteria 1 to 3 was present, VT was diagnosed; when absent, the next criterion was analyzed. In step 4, vi/vt >1 suggested SVT, and vi/vt ≤1 suggested VT. Results: The accuracy of the new aVR algorithm and our previous algorithm was superior to that of the Brugada algorithm (P = .002 and P = .007, respectively). The aVR algorithm and our previous algorithm had greater sensitivity (P <.001 and P = .001, respectively) and negative predictive value for diagnosing VT and greater specificity (P <.001 and P = .001, respectively) and positive predictive value for diagnosing SVT compared with the Brugada criteria. Conclusion: The simplified aVR algorithm classified wide QRS complex tachycardias with the same accuracy as standard criteria and our previous algorithm and was superior to the Brugada algorithm.

Original languageEnglish
Pages (from-to)89-98
Number of pages10
JournalHeart Rhythm
Volume5
Issue number1
DOIs
StatePublished - Jan 2008

Fingerprint

Tachycardia
Differential Diagnosis
Ventricular Tachycardia
Supraventricular Tachycardia
Electrocardiography

Keywords

  • Brugada criteria
  • Supraventricular tachycardia
  • Ventricular tachycardia
  • Wide QRS complex tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. / Vereckei, András; Duray, Gábor; Szénási, Gábor; Altemose, Gregory T.; Miller, John.

In: Heart Rhythm, Vol. 5, No. 1, 01.2008, p. 89-98.

Research output: Contribution to journalArticle

Vereckei, András ; Duray, Gábor ; Szénási, Gábor ; Altemose, Gregory T. ; Miller, John. / New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. In: Heart Rhythm. 2008 ; Vol. 5, No. 1. pp. 89-98.
@article{fe603089b7254621b9bec139be2e6ffb,
title = "New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia",
abstract = "Background: We recently reported an ECG algorithm for differential diagnosis of regular wide QRS complex tachycardias that was superior to the Brugada algorithm. Objective: The purpose of this study was to further simplify the algorithm by omitting the complicated morphologic criteria and restricting the analysis to lead aVR. Methods: In this study, 483 wide QRS complex tachycardias [351 ventricular tachycardias (VTs), 112 supraventricular tachycardias (SVTs), 20 preexcited tachycardias] from 313 patients with proven diagnoses were prospectively analyzed by two of the authors blinded to the diagnosis. Lead aVR was analyzed for (1) presence of an initial R wave, (2) width of an initial r or q wave >40 ms, (3) notching on the initial downstroke of a predominantly negative QRS complex, and (4) ventricular activation-velocity ratio (vi/vt), the vertical excursion (in millivolts) recorded during the initial (vi) and terminal (vt) 40 ms of the QRS complex. When any of criteria 1 to 3 was present, VT was diagnosed; when absent, the next criterion was analyzed. In step 4, vi/vt >1 suggested SVT, and vi/vt ≤1 suggested VT. Results: The accuracy of the new aVR algorithm and our previous algorithm was superior to that of the Brugada algorithm (P = .002 and P = .007, respectively). The aVR algorithm and our previous algorithm had greater sensitivity (P <.001 and P = .001, respectively) and negative predictive value for diagnosing VT and greater specificity (P <.001 and P = .001, respectively) and positive predictive value for diagnosing SVT compared with the Brugada criteria. Conclusion: The simplified aVR algorithm classified wide QRS complex tachycardias with the same accuracy as standard criteria and our previous algorithm and was superior to the Brugada algorithm.",
keywords = "Brugada criteria, Supraventricular tachycardia, Ventricular tachycardia, Wide QRS complex tachycardia",
author = "Andr{\'a}s Vereckei and G{\'a}bor Duray and G{\'a}bor Sz{\'e}n{\'a}si and Altemose, {Gregory T.} and John Miller",
year = "2008",
month = "1",
doi = "10.1016/j.hrthm.2007.09.020",
language = "English",
volume = "5",
pages = "89--98",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "1",

}

TY - JOUR

T1 - New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia

AU - Vereckei, András

AU - Duray, Gábor

AU - Szénási, Gábor

AU - Altemose, Gregory T.

AU - Miller, John

PY - 2008/1

Y1 - 2008/1

N2 - Background: We recently reported an ECG algorithm for differential diagnosis of regular wide QRS complex tachycardias that was superior to the Brugada algorithm. Objective: The purpose of this study was to further simplify the algorithm by omitting the complicated morphologic criteria and restricting the analysis to lead aVR. Methods: In this study, 483 wide QRS complex tachycardias [351 ventricular tachycardias (VTs), 112 supraventricular tachycardias (SVTs), 20 preexcited tachycardias] from 313 patients with proven diagnoses were prospectively analyzed by two of the authors blinded to the diagnosis. Lead aVR was analyzed for (1) presence of an initial R wave, (2) width of an initial r or q wave >40 ms, (3) notching on the initial downstroke of a predominantly negative QRS complex, and (4) ventricular activation-velocity ratio (vi/vt), the vertical excursion (in millivolts) recorded during the initial (vi) and terminal (vt) 40 ms of the QRS complex. When any of criteria 1 to 3 was present, VT was diagnosed; when absent, the next criterion was analyzed. In step 4, vi/vt >1 suggested SVT, and vi/vt ≤1 suggested VT. Results: The accuracy of the new aVR algorithm and our previous algorithm was superior to that of the Brugada algorithm (P = .002 and P = .007, respectively). The aVR algorithm and our previous algorithm had greater sensitivity (P <.001 and P = .001, respectively) and negative predictive value for diagnosing VT and greater specificity (P <.001 and P = .001, respectively) and positive predictive value for diagnosing SVT compared with the Brugada criteria. Conclusion: The simplified aVR algorithm classified wide QRS complex tachycardias with the same accuracy as standard criteria and our previous algorithm and was superior to the Brugada algorithm.

AB - Background: We recently reported an ECG algorithm for differential diagnosis of regular wide QRS complex tachycardias that was superior to the Brugada algorithm. Objective: The purpose of this study was to further simplify the algorithm by omitting the complicated morphologic criteria and restricting the analysis to lead aVR. Methods: In this study, 483 wide QRS complex tachycardias [351 ventricular tachycardias (VTs), 112 supraventricular tachycardias (SVTs), 20 preexcited tachycardias] from 313 patients with proven diagnoses were prospectively analyzed by two of the authors blinded to the diagnosis. Lead aVR was analyzed for (1) presence of an initial R wave, (2) width of an initial r or q wave >40 ms, (3) notching on the initial downstroke of a predominantly negative QRS complex, and (4) ventricular activation-velocity ratio (vi/vt), the vertical excursion (in millivolts) recorded during the initial (vi) and terminal (vt) 40 ms of the QRS complex. When any of criteria 1 to 3 was present, VT was diagnosed; when absent, the next criterion was analyzed. In step 4, vi/vt >1 suggested SVT, and vi/vt ≤1 suggested VT. Results: The accuracy of the new aVR algorithm and our previous algorithm was superior to that of the Brugada algorithm (P = .002 and P = .007, respectively). The aVR algorithm and our previous algorithm had greater sensitivity (P <.001 and P = .001, respectively) and negative predictive value for diagnosing VT and greater specificity (P <.001 and P = .001, respectively) and positive predictive value for diagnosing SVT compared with the Brugada criteria. Conclusion: The simplified aVR algorithm classified wide QRS complex tachycardias with the same accuracy as standard criteria and our previous algorithm and was superior to the Brugada algorithm.

KW - Brugada criteria

KW - Supraventricular tachycardia

KW - Ventricular tachycardia

KW - Wide QRS complex tachycardia

UR - http://www.scopus.com/inward/record.url?scp=37549006716&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=37549006716&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2007.09.020

DO - 10.1016/j.hrthm.2007.09.020

M3 - Article

VL - 5

SP - 89

EP - 98

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 1

ER -