Differential diagnosis of wide QRS tachycardias: comparison of two electrocardiographic algorithms

Abstract

Both algorithms as a whole are similar for diagnosis of WTC; however, the first step of Vereckei (initial R in aVR) is a simple, reproducible, accurate, and fast tool to use. The negativity of this step requires a 'holistic' approach to distinguish VT from SVT.

A scoring algorithm for the accurate differential diagnosis of regular wide QRS complex tachycardia

“…Therefore, many criteria and algorithms have been described to help make this differential diagnosis, all of which are based on an ECG analysis during tachycardia. All of these algorithms have their value as well as their limitations, and most are subjective in their application, resulting in high interobserver variability when applied to the real world …”

“…All of these algorithms have their value as well as their limitations, and most are subjective in their application, resulting in high interobserver variability when applied to the real world. 1,4 F I G U R E 2 Panel A shows the baseline ECG (a) and the ECG during tachycardia (b) in a case fulfilling the criteria "tachycardia QRS morphology identical to QRS on baseline ECG." Therefore, the algorithm score was -1, leading to a diagnosis of SVT, that in fact was an atrioventricular nodal reentrant tachycardia.…”

“…The differential diagnosis of regular wide QRS complex tachycardia (RWQRST) in cases of supraventricular tachycardia (SVT) and ventricular tachycardia (VT) remains a topic of clinical interest and the subject of numerous publications . All of these studies address the differential electrocardiographic diagnosis of RWQRST during the acute clinical phase.…”

“…The differential diagnosis of regular wide QRS complex tachycardia (RWQRST) in cases of supraventricular tachycardia (SVT) and ventricular tachycardia (VT) remains a topic of clinical interest and the subject of numerous publications. [1][2][3][4][5][6][7][8][9][10][11][12][13] All of these studies address the differential electrocardiographic diagnosis of RWQRST during the acute clinical phase. However, this emergency diagnosis is not the primary problem because a treatment decision can be based on probability at the time of worst-case scenarios; for example, a patient with RWQRST and known structural heart disease (e.g., tachycardia) will be considered as having VT and treated as such, which will be adequate in most cases.…”

Análise de um novo critério de interpretação no diagnóstico diferencial das taquicardias de complexo QRS largo

“…Sem dados adicionais, como eletrograma endocavitário ou esofágico, dados clínicos e diagnóstico prévio da origem da taquicardia de QRS largo, solicitamos aos Brugada et al 39 não tenham sido reproduzidos no presente estudo, achado este já relatado por outros autores 47,62 e, dentre uma das possíveis explicações, estaria a de que os observadores utilizados no desenvolvimento do algoritmo de 39 , visto que esse estudo não mostrou dados em relação à pacientes com bloqueio de ramo preexistente, TV idiopática, TSV pré-excitada, ou TSV-A em pacientes com insuficiência cardíaca, situações em que provavelmente os critérios atuais não são aplicáveis 63,64 . Essa não informação, ou exclusão intencional desses ECGs, pode melhorar o desempenho de um algoritmo ou critério eletrocardiográfico.…”