Specificity of wide QRS complex tachycardia criteria and algorithms in patients with ventricular preexcitation

Jastrzębski, Marek; Moskal, P.; Kukla, Piotr; Fijorek, Kamil; Kisiel, Roksana; Czarnecka, Danuta

doi:10.1111/anec.12493

Cited by 14 publications

(20 citation statements)

References 21 publications

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“…Antidromic AV reentrant tachycardia will produce a WQRST, but the QRS morphology will depend on the location of the accessory pathway along the AV ring and its ventricular insertion site. The QRS morphology will resemble the morphology of the delta wave observed during sinus rhythm as the ventricle is pre‐excited by the accessory pathway bypassing the AV node and His‐Purkinje system 37,38 …”

Section: Pre‐excited Tachyc Ardiamentioning

confidence: 99%

Differential diagnosis of wide QRS tachycardia: A review

Abedin

2021

Journal of Arrhythmia

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Differential diagnosis of wide QRS tachycardia (WQRST) on the electrocardiogram remains a challenging exercise. Correct diagnosis is important for prescribing appropriate therapy and determining prognosis. Differential diagnosis of wide QRS tachycardia revolves around differentiation between supraventricular tachycardia with aberrant conduction and ventricular tachycardia. Observations such as clinical history, findings of physical examination during tachycardia, AV dissociation, QRS morphology in lead V1 and lead V6, precordial concordance, RS complexes in precordial leads, contralateral bundle branch block during wide QRS tachycardia, R wave morphologies in lead aVR, and ventricular initial/terminal velocity of conduction ratio can help arrive at the correct diagnosis with reasonable accuracy. The observations described here can help arrive at the correct diagnosis of WQRST with both reasonable accuracy and confidence.

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Section: Pre‐excited Tachyc Ardiamentioning

confidence: 99%

Differential diagnosis of wide QRS tachycardia: A review

Abedin

2021

Journal of Arrhythmia

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“…However, during provoked or spontaneous maximal preexcitation, ventricular activation accomplished almost exclusively by the AP is observed, with the QRS morphology almost completely depending on the AP location (FIgUrE 1). 8 Variability in the degree of preexcitation in the QRS morphology can explain the difficulty whAt's new?…”

Section: O R I G I N a L A R T I C L Ementioning

confidence: 99%

Increased preexcitation on electrocardiography improves accuracy of algorithms for accessory pathway localization in Wolff–Parkinson–White syndrome

Moskal¹,

Bednarski²,

Kiełbasa³

et al. 2020

Kardiol Pol

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Background Several electrocardiographic (ECG) algorithms have been developed for predicting accessory pathway (AP) location in Wolff-Parkinson-White syndrome. However, their accuracy may be related to the manifested degree of preexcitation on ECG. aims Our goal was to assess the effect of the degree of preexcitation on the accuracy of 4 traditional AP localization algorithms and to compare them with the algorithm specifically designed for ECGs with maximal preexcitation (Pambrun). methods The study included 300 patients who underwent successful ablation of an overt atrioventricular AP. Resting and maximally preexcited ECGs obtained during incremental atrial pacing were assessed using 4 traditional AP localization algorithms: Xie, d'Avila, Iturralde, and Taguchi. Maximally preexcited ECGs were additionally assessed with the Pambrun algorithm. We compared the precision of the algorithms to predict accurate or anatomically adjacent AP location. results The overall accuracy of traditional AP localization algorithms using resting ECG ranged between 26% and 53.7% and improved to a range of 47.3% to 69.7% when adjacent locations were accepted. When used with maximal preexcitation, all algorithms had significantly higher accuracy, with a mean improvement of 14.3 and 15.6 percentage points for precise and adjacent sites, respectively. The Pambrun algorithm for maximally preexcited ECGs had the highest precision for both accurate and adjacent locations of the APs (89.7% and 97%, respectively). conclusions Greater preexcitation on ECG improved the accuracy of the traditional AP localization algorithms. The algorithm designed to use maximally preexcited ECGs has the best accuracy. Maximally preexcited ECG recordings should preferably be used in clinical practice to facilitate the ablation procedure.

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“…10,16 All from this analysis were found to have a sensitivity of 75% and specificity of 100% and the algorithm was validated in another study but experience is still limited. 18,19 Several independent studies have found that various ECG-based methods have specificities of 40-80% and accuracies of ~75%. 2,10,[19][20][21][22] A similar diagnostic accuracy of ~75% would be achieved effortlessly by considering every wide QRS tachycardia to be a VT because only 25-30% are SVTs.…”

Section: Rs Interval In the Precordial Leadsmentioning

confidence: 99%

“…18,19 Several independent studies have found that various ECG-based methods have specificities of 40-80% and accuracies of ~75%. 2,10,[19][20][21][22] A similar diagnostic accuracy of ~75% would be achieved effortlessly by considering every wide QRS tachycardia to be a VT because only 25-30% are SVTs. Emerging approaches to integrate these algorithms to provide more accurate scoring systems are being evaluated.…”

Section: Rs Interval In the Precordial Leadsmentioning

confidence: 99%