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The VT Prediction Model: A simplified means to differentiate wide complex tachycardias

Adam M. May Christopher V. DeSimone Anthony H. Kashou Haarini Sridhar David O. Hodge Rickey Carter Grace Lin Samuel J. Asirvatham Peter A. Noseworthy Abhishek J. Deshmukh 《Journal of cardiovascular electrophysiology》2020,31(1):185-195

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Novel criterion for the differential diagnosis of wide QRS complexes and wide complex tachycardia using the initial activation of QRS on leads V1 and V2: Differential diagnosis of wide QRS based on V1-V2

Imane El Hajjaji Giuliano Becker Teresa Kus Alain Vinet Artur Berkovitz Marcio Sturmer 《Journal of electrocardiology》2018,51(4):700-706

Background

Many diagnostic criteria for the differential diagnosis of wide complex tachycardia (WCT) are complex and not completely accurate. Incorrect diagnosis is also related to error in applying criteria.

Objectives

To propose a novel reliable criterion for wide QRS complexes' differential diagnosis.

Material and methods

One hundred Electrocardiograms (ECGs) with wide QRS complexes were analyzed using the ECG software. Five variables were measured during the first 20?ms of QRS in leads V1 and V2 and compared between premature ventricular contraction (PVC) and conducted supraventricular impulse with bundle branch block (BBB) groups. The best discriminant variable was identified. The validity of this variable was tested on a group of 20 patients who had WCT during an electrophysiology study.

Results

Almost all variables were statistically different between PVC and BBB groups. The sum of voltages in absolute value of vectors during the initial 20?ms of the QRS in leads V1 and V2 (ΣV1?+?V2) was the most discriminant between the two groups (131?±?85 microvolt [μV] vs. 498?±?392?μV, p?<?0.01). A ΣV1?+?V2?<?258?μV (rounded to <0.25?millivolt [mV]) diagnosed PVCs with good sensitivity and specificity (90% and 85% respectively). The ΣV1?+?V2 in WCT group had lower values in VT versus supra-ventricular tachycardia (SVT) group (0.53?±?0.35?mV vs. 1.79?±?1.04?mV, p?=?0.004).

Conclusions

The ΣV1?+?V2?<?258?μV is a reliable criterion for PVC diagnosis. It could be measured accurately using ECG Software, which could be programmed to calculate it automatically, limiting the risk of human error. The ΣV1?+?V2 also seems capable of discriminating between VT and SVT. 相似文献