Vereckei et al developed an algorithm for evaluating a patient with wide QRS complex tachycardia. The authors are from Semmelweis University (Budapest), Cardiovascular Center (Budapest), Mayo Clinic Scottsdale, Indiana University, and Krannert Institute of Cardiology (Indianapolis).
Differential diagnosis of wide QRS complex tachycardia:
(1) ventricular tachycardia (VT)
(2) supraventricular tachycardia (SVT)
Questions:
(1) Is A-V dissociation present?
(2) Is an initial R wave present in aVR?
(3) Is QRS morphology unlike bundle branch block (BBB) or fascicular block?
(4) Is the ratio of vi to vt <= 1? (vi = initial ventricular activation velocity; vt = terminal ventricular activation velocity)
|
Q(1) |
Q(2) |
Q(3) |
Q(4) |
Diagnosis |
Group |
|
Yes |
|
|
|
ventricular tachycardia |
1 |
|
No |
Yes |
|
|
ventricular tachycardia |
2 |
|
No |
No |
Yes |
|
ventricular tachycardia |
3 |
|
No |
No |
No |
Yes |
ventricular tachycardia |
4 |
|
No |
No |
No |
No |
supraventricular tachycardia |
5 |
where:
• The wording on question 3 invites confusion.
Performance in 453 patients (348 ventricular tachycardia, 105 SVT, Figure 7)
|
Group |
VT |
SVT |
|
1 |
35 |
0 |
|
2 |
124 |
3 |
|
3 |
139 |
17 |
|
4 |
35 |
9 |
|
5 |
15 |
76 |
Performance (pages 6-8, including comparison with the Brugada criteria):
• Correctly classified 90% of patients.
• The specificity for VT = sensitivity for SVT. The sensitivity for VT = specificity for SVT. The PPV for VT = NPV SVT.
• The sensitivity for VT was 95.7%;
Specialty: Cardiology
