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Comparison of five electrocardiographic methods for differentiation of wide QRS-complex tachycardias

EUROPACE 2012年第8期14卷 1165-1171页

作者： Jastrzebski, Marek Kukla, Piotr Czarnecka, Danuta Kawecka-Jaszcz, Kalina Univ Hosp Dept Cardiol & Hypertens 1 PL-31501 Krakow Poland H Klimontowicz Specialist Hosp Dept Internal Med Gorlice Poland Jagiellonian Univ Coll Med Dept Cardiol & Hypertens 1 Krakow Poland

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.

关键词： Ventricular tachycardia Supraventricular tachycardia Wide QRS-complex tachycardia Brugada algorithm avr algorithm

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Specificity of the wide QRS complex tachycardia algorithms in recipients of cardiac resynchronization therapy

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JOURNAL OF ELECTROCARDIOLOGY 2012年第3期45卷 319-326页

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.

关键词： Wide QRS complex tachycardia Brugada algorithm avr algorithm Griffith algorithm Bayesian algorithm

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