Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia. |
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Authors: | András Vereckei Gábor Duray Gábor Szénási Gregory T Altemose John M Miller |
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Institution: | Third Department of Medicine, Semmelweis University, School of Medicine, Budapest, Kútv?lgyi út 4, Hungary 1125. vereckei@kut.sote.hu |
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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)
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Keywords: | Wide QRS complex tachycardia Brugada criteria Ventricular tachycardia Supraventricular tachycardia |
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