The Differential Diagnosis of Wide Complex Tachycardia—ED Diagnostic and Management Considerations

Charlton, Nathan P.; Brady, William J.

doi:10.1002/9781119959809.ch8

Cardiovascular Problems in Emergency Medicine 2011

DOI: 10.1002/9781119959809.ch8

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The Differential Diagnosis of Wide Complex Tachycardia—ED Diagnostic and Management Considerations

Nathan P. Charlton

William J. Brady

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2013

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“…Thus, the great preponderance of VT as the underlying cause of WCT might reflect the bias of difficult cases referred to electrophysiologic testing centers. According to some observations, the emergency physician might encounter VT less frequently and more commonly encounter other underlying causes of WCT in the emergency department …”

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confidence: 99%

Comparison of the “Real-life” Diagnostic Value of Two Recently Published Electrocardiogram Methods for the Differential Diagnosis of Wide QRS Complex Tachycardias

Szelényi

Duray²,

Katona

et al. 2013

Acad Emerg Med

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Objectives: The diagnostic values of the aVR lead or "Vereckei algorithm," and the lead II R-wave peak time (RWPT) criterion, recently devised for the differential diagnosis of wide QRS complex tachycardias (WCTs), were compared.Methods: A total of 212 WCTs (142 ventricular tachycardias [VTs], 62 supraventricular tachycardias [SVT], and eight preexcitation SVTs) from 145 patients with proven electrophysiologic diagnoses were retrospectively analyzed by seven examiners blinded to the electrophysiologic diagnoses. Results:The overall test accuracy of the Vereckei algorithm was superior to that of the RWPT criterion (84.3% vs. 79.6%; p = 0.0003). The sensitivity of the Vereckei algorithm for VT diagnosis was greater than that of RWPT criterion (92.4% vs. 79.1%; p < 0.0001). The negative predictive value (NPV) for the Vereckei algorithm was also greater (77.8%; 95% confidence interval [CI] = 73.6% to 82.1%) than that of the RWPT criterion (61.6%; 95% CI = 57.6% to 65.6%). The specificity of the Vereckei algorithm was lower than that of the RWPT criterion (64.7% vs. 80.9%; p < 0.0001). The positive predictive value (PPV) was also lower for the Vereckei algorithm (86.4%; 95% CI = 84.4% to 88.4%) than for the RWPT criterion (90.9%; 95% CI = 89.1% to 92.8%). Incorrect diagnoses made by the Vereckei algorithm were mainly due to misdiagnosis of SVT as VT (65.7% of cases), and those made by the RWPT criterion were due to the more dangerous misdiagnosis of VT as SVT (72.5% of cases). Conclusions:The Vereckei algorithm was superior in overall test accuracy, sensitivity, and NPV for VT diagnosis and inferior in specificity and PPV to the RWPT criterion. All of these parameters were lower in "real life" than those reported by the original authors for each of the particular electrocardiographic methods.ACADEMIC EMERGENCY MEDICINE 2013; 20:1121-1130 © 2013 by the Society for Academic Emergency Medicine E lucidation of the mechanism of sustained, monomorphic wide QRS complex tachycardia (WCT) is a common diagnostic dilemma for the emergency physician. When confronted with the 12-lead WCT electrocardiogram (ECG), a correct diagnosis is vital not only for acute dysrhythmia treatment, but for further prognosis and subsequent work-up, as well as management. Because ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with aberrant intraventricular conduction account for the vast majority of WCTs (80 and 15% to 20%, respectively), the clinically relevant problem is the distinction of VT from SVT with aberrant intraventricular conduction (SVT-A) in the differential diagnosis of WCTs. Other rare causes of WCT, such as SVT with anterograde conduction over an accessory pathway (preexcitation SVT), drug toxicity, electrolyte disorders (hyperkalemia), ventricular paced rhythm, or ECG artifact, account for only a small

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mentioning

confidence: 99%

Comparison of the “Real-life” Diagnostic Value of Two Recently Published Electrocardiogram Methods for the Differential Diagnosis of Wide QRS Complex Tachycardias

Szelényi

Duray²,

Katona

et al. 2013

Acad Emerg Med

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The Differential Diagnosis of Wide Complex Tachycardia—ED Diagnostic and Management Considerations

Cited by 1 publication

References 22 publications

Comparison of the “Real-life” Diagnostic Value of Two Recently Published Electrocardiogram Methods for the Differential Diagnosis of Wide QRS Complex Tachycardias

Comparison of the “Real-life” Diagnostic Value of Two Recently Published Electrocardiogram Methods for the Differential Diagnosis of Wide QRS Complex Tachycardias

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