Limitations of the negative concordance pattern in the diagnosis of broad QRS tachycardia

Barold, S. Serge; Stroobandt, Roland X.; Herweg, Bengt

doi:10.1016/j.jelectrocard.2012.06.017

Cited by 6 publications

(9 citation statements)

References 20 publications

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“…There are several algorithms that are currently used to help distinguish Supraventricular Tachycardia (SVT) with aberrancy and Ventricular Tachycardia (VT) (Table 3). Many of these algorithms and criteria have limitations [44][45][46][47][48][49][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71].…”

Section: Ecg Criteria Favoring Ventricular Rather Than Supra-ventricu...mentioning

confidence: 99%

“…[RBBB morphology, LBBB morphology] Precordial concordance = VT. A QRS, which is predominantly positive or predominantly negative in every precordial lead, overwhelmingly favors VT with specificity of 95-100% and a PPV of 89-100% [44][45][46][47][48][49][50][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71].…”

Section: Sandler and Marriott Criteria (1965)mentioning

confidence: 99%

“…[RBBB morphology] Rsr' ('Rabbit ears') = VT. In an unusual triphasic V1, with the left R wave taller than the right, and the S wave not crossing the baseline, favors VT with PPV of 100% [44][45][46][47][48][49][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71].…”

Section: Wellens Criteria Of Right Bundle Branch Blockmentioning

confidence: 99%

“…A history of myocardial infarction, QRS morphology in leads aVF and V1 ( [1] predominant negative deflection in aVF in tachycardia with RBBB pattern and Q wave, [2] a monophasic or biphasic waveform in V1 in tachycardia with RBBB pattern, [3] QS or qR waveform in tachycardia with LBBB pattern favored a diagnosis of VT) and frontal plane axis > 40° when compared with baseline the ECG favored a diagnosis of VT. The presence of AV dissociation and/or the presence of premature ventricular beats during sinus rhythm that show morphologies same to that observed in tachycardia favored a diagnosis of VT [51][52][53][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71]. negative, has been reported to have a sensitivity of 93% and specificity of 99% for identifying VT (Figure 4) [55,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71].…”

Section: Griffith Criteriamentioning

confidence: 99%

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Electrocardiographic Differential Diagnosis of Narrow QRS and Wide QRS Complex Tachycardias

Song¹

2023

Clinical Use of Electrocardiogram

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Narrow QRS complex tachycardias or Wide QRS complex tachycardias are common problems encountered in clinical practices. Although such tachycardias often occur in patients with a normal anatomy and/or function of heart and rarely represent life-threatening conditions, they are common sources of morbidity and/or mortality. Narrow QRS complex tachycardias are fast cardiac rhythms with QRS duration of 120 ms or less while wide QRS complex tachycardias are fast cardiac rhythms with QRS duration of 120 ms or more. Origins of narrow QRS complex tachycardias are above or within the His bundle. Wide QRS complex tachycardias can be ventricular tachycardias, supra-ventricular tachycardias with bundle branch block or accessory pathway. The purpose of this chapter is to present the differential diagnosis of narrow and wide QRS complex tachycardias.

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Section: Ecg Criteria Favoring Ventricular Rather Than Supra-ventricu...mentioning

confidence: 99%

Section: Sandler and Marriott Criteria (1965)mentioning

confidence: 99%

Section: Wellens Criteria Of Right Bundle Branch Blockmentioning

confidence: 99%

Section: Griffith Criteriamentioning

confidence: 99%

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Electrocardiographic Differential Diagnosis of Narrow QRS and Wide QRS Complex Tachycardias

Song¹

2023

Clinical Use of Electrocardiogram

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“…Negative concordance, when strictly defined (QRS complexes are negative i. e. QS complexes are present in all precordial leads), nearly always caused by VT. However, rarely patients with heart failure, cardiomyopathy and very dilated hearts with LBBB pattern or patients with an abnormal anatomical position of the heart, such as in patients with pectus excavatum, where the right ventricle lies completely under the anterolateral precordial area, may manifest with negative concordance during an SVT [4, 6, 28, 29]. Concordance is a very specific (>90% specificity) but insensitive criterion for VT, because only about 20% of all VTs have a concordant pattern, which is approximately evenly split between positive and negative concordance [6].…”

Section: Patient History and Physical Examination In Wct Differentialmentioning

confidence: 99%

Current Algorithms for the Diagnosis of wide QRS Complex Tachycardias

Vereckei

2014

CCR

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The differential diagnosis of a regular, monomorphic wide QRS complex tachycardia (WCT) mechanism represents a great diagnostic dilemma commonly encountered by the practicing physician, which has important implications for acute arrhythmia management, further work-up, prognosis and chronic management as well. This comprehensive review discusses the causes and differential diagnosis of WCT, and since the ECG remains the cornerstone of WCT differential diagnosis, focuses on the application and diagnostic value of different ECG criteria and algorithms in this setting and also provides a practical clinical approach to patients with WCTs.

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