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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 |
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| Authors: | Imane El Hajjaji Giuliano Becker Teresa Kus Alain Vinet Artur Berkovitz Marcio Sturmer |
| Affiliation: | 1. Cardiology Department, Hôpital du Sacré-C?ur de Montréal, Université de Montréal, Canada;2. Department of Pharmacology and Physiology, Institut de Génie Biomédical, Université de Montréal and Centre de Recherche de l''Hôpital du Sacré-Coeur de Montréal, Canada |
| Abstract: | BackgroundMany 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.ObjectivesTo propose a novel reliable criterion for wide QRS complexes' differential diagnosis.Material and methodsOne 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.ResultsAlmost 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?ConclusionsThe ΣV1?+?V2? |
| Keywords: | BBB bundle brunch block dV the delta voltage dV1 the delta voltage in lead V1 dV2 the delta voltage in lead V2 ECG electrocardiogram EPS electrophysiology study fV the voltage of the first vector fV1 the voltage of the first vector in lead V1 fV2 the voltage of the first vector in lead V2 LBBB left bundle branch block LFB left fascicular block ms milliseconds mV millivolt μV microvolt PSVC premature supraventricular contraction PVC premature ventricular contraction RBBB right bundle branch block ROC receiver operating characteristic SR sinus rhythm ΣV the sum of the voltages in absolute value of all vectors ΣV1 the sum of the voltages in absolute value of all vectors in lead V1 ΣV2 the sum of the voltages in absolute value of all vectors in lead V2 ΣV1?+?V2 the sum of the values of the sum of the voltages in absolute value of all vectors obtained in both leads V1 and V2 tV the time duration in milliseconds of the first vector tV1 the time duration in milliseconds of the first vector in lead V1 tV2 the time duration in milliseconds of the first vector in lead V2 WCT wide complex tachycardia Wide QRS Wide complex tachycardia Differential diagnosis |
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