To compare the sensitivity (SN), specificity (SP), and diagnostic accuracy (ACC) for ventricular tachycardia (VT) diagnosis of five electrocardiographic methods for wide QRS-complex tachycardia (WCT) differentiation, ...
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To compare the sensitivity (SN), specificity (SP), and diagnostic accuracy (ACC) for ventricular tachycardia (VT) diagnosis of five electrocardiographic methods for wide QRS-complex tachycardia (WCT) differentiation, specifically the brugada, Bayesian, Griffith, and aVR algorithms, and the lead II R-wave-peak-time (RWPT) criterion. We retrospectively analysed 260 WCTs from 204 patients with proven diagnoses. The SN, SP, ACC, and likelihood ratios (LRs) were determined for the five methods. Of the 260 tracings, there were 159 VTs and 101 supraventricular tachycardias. All five methods were found to have a similar ACC although the RWPT had a lower ACC than the brugada algorithm (68.8 vs. 77.5, P 0.04). The RWPT had lower (60) SN than the brugada (89.0), Griffith (94.2), and Bayesian (89) algorithms (P 0.001). The Griffith algorithm showed lower (39.8) SP than the RWPT (82.7), brugada (59.2), and Bayesian (52.0) algorithms (P 0.05). The positive LRs for a VT diagnosis for the RWPT criterion and the brugada, Bayesian, aVR, and Griffith algorithms were 3.46, 2.18, 1.86, 1.67, and 1.56, respectively. The present study is the first independent ohead-to-head' comparison of several WCT differentiation methods. We found that all five algorithms/criteria had rather moderate ACC, and that the newer methods were not more accurate than the classic brugada algorithm. However, the algorithms/criteria differed significantly in terms of SN, SP, and LR, suggesting that the value of a diagnosis may differ depending on the method used.
Background: We assessed the specificity of wide QRS complex tachycardia (WCT) differentiating algorithms in patients with preexistent left bundle branch block (LBBB) and heart failure. Methods: Three hundred fourteen ...
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Background: We assessed the specificity of wide QRS complex tachycardia (WCT) differentiating algorithms in patients with preexistent left bundle branch block (LBBB) and heart failure. Methods: Three hundred fourteen patients with resynchronization devices were retrospectively screened. electrocardiograms with supraventricular LBBB rhythm were used as a surrogate for supraventricular tachycardia QRS morphology. The Pava lead II criterion, ventricular activation velocity ratio (Vi/Vt) ratio in V-2, Vereckei aVR, brugada, Griffith, and Bayesian algorithms were investigated. Results: The WCT algorithms had a lower specificity (33%-69%) in patients with LBBB than in general WCT populations. The Pava lead II criterion and brugada algorithm had higher specificity than other algorithms (P<.05). Several of the single criteria (absence of an RS complex in V-1 through V-6, initial R wave in aVR, Vi/Vt <1 in V-2) had specificities of 92% to 99%. Conclusions: In patients with heart failure and LBBB, an electrocardiographic diagnosis of ventricular tachycardia should be based on selected, specific criteria rather than on WCT algorithms. (C) 2012 Elsevier Inc. All rights reserved.
This study's aim is to compare the ability of two ECG criteria to differentiate ventricular (VT) from supraventricular tachycardia (SVT): brugada et al. [horizontal plane (HP) leads] and Vereckei et al. [frontal p...
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This study's aim is to compare the ability of two ECG criteria to differentiate ventricular (VT) from supraventricular tachycardia (SVT): brugada et al. [horizontal plane (HP) leads] and Vereckei et al. [frontal plane (FP), specifically aVR lead], having electrophysiological study (EPS) as gold standard. After comparing, suggestions for better diagnosis of wide QRS-complex tachycardia (WCT) in emergency situations were made. Fifty-one consecutive patients with 12-lead ECG registered during EPS-induced regular WCT were selected. Each ECG was split into two parts: HP (V1-V6) and FP (D1-D3, aVR, aVL, and aVF), randomly distributed to three observers, blinded for EPS diagnosis and complementary ECG plane, resulting in total 306 ECG analyses. Observers followed the four steps of both algorithms, counting time-to-diagnosis. Global sensitivity, specificity, percentage of incorrect diagnoses, and step-by-step positive/negative likelihood ratios (+LR and -LR) were calculated. Kaplan-Meier curve was plotted for final time-to-diagnosis. Inter-observer agreement was assessed with kappa-statistic. Global sensitivity was similarly high in FP and HP algorithms (89.2 vs. 90.1%), and incorrect classifications were 27.4 vs. 24.7%. Forty-eight correct analyses by Vereckei criteria took 9.13 s to diagnose VT in the first step, showing that first step was fast, with high +LR, generating nearly conclusive pre- (72.6%) to post-test (98.0%) changes for VT probability. 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.
Electrocardiographic diagnosis of wide QRS complex tachycardia (WCT) continues to be challenging as none one of the available methods is specific for ventricular tachycardia (VT) diagnosis. We aimed to construct a met...
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Electrocardiographic diagnosis of wide QRS complex tachycardia (WCT) continues to be challenging as none one of the available methods is specific for ventricular tachycardia (VT) diagnosis. We aimed to construct a method for WCT differentiation based on a scoring system, in which ECGs are graded according to the number of VT-specific features. This novel method was validated and compared with brugada algorithm and other methods. A total of 786 WCTs (512 VTs) from 587 consecutive patients with a proven diagnosis were analysed by two blinded observers. The VT score method was based on seven ECG features: initial R wave in V1, initial r > 40 ms in V1/V2, notched S in V1, initial R in aVR, lead II R wave peak time a parts per thousand yen50 ms, no RS in V1-V6, and atrioventricular dissociation. Atrioventricular dissociation was assigned two points, and each of the other features was assigned one point. The overall accuracy of VT score a parts per thousand yen1 for VT diagnosis (83%) was higher than that of the aVR (72%, P = 0.001) and brugada (81%) algorithms. Ventricular tachycardia score a parts per thousand yen3 was present in 66% of VTs and was more specific (99.6%) than any other algorithm/criterion for VT diagnosis. Ventricular tachycardia score a parts per thousand yen4 was present in 33% of VTs and was 100% specific for VT. The new ECG-based method provides a certain diagnosis of VT in the majority of patients with VT, identifies unequivocal ECGs, and has superior overall diagnostic accuracy to other ECG methods.
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