Electrocardiographic criteria for ventricular tachycardia in wide complex left bundle branch block morphology tachycardias
Abstract
Four electrocardiographic criteria for ventricular tachycardia (VT) were proposed and evaluated. These included (1) an R wave in V1 or V2 of greater than 30-ms duration; (2) any Q wave in V6; (3) a duration of greater than 60 ms from the onset of the QRS to the nadir of the S wave in V1 or V2 and (4) notching on the downstroke of the S wave in V1 or V2. The data showed that all 4 criteria had high predictive accuracy (96 to 100%) and specificity (94 to 100%). The relatively low sensitivities of the 4 criteria alone (30 to 64%) might limit their efficacy. Grouped criteria, however, could differentiate VT from supraventricular tachycardias with high sensitivity, specificity and predictive accuracy. The amount of tracings having either electrocardiographic criteria (1) or (2) or (3) or (4) was determined. The proposed combined criteria had a sensitivity of 100%, specificity of 89% and a predictive accuracy of 96%. Left axis deviation alone was of no value in distinguishing VT from supraventricular tachycardia. Characteristic patterns were present for left bundle branch block pattern VT associated with anterior and inferior myocardial infarction. In conclusion, the 12-lead electrocardiogram alone, when systematically analyzed, can be used to accurately diagnose the origin of wide complex tachycardias with left bundle branch block pattern. Attention to these criteria may lead to more rapid and effective therapy.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In LBBB morphology, the presence of broad R wave, slurred or notched down stroke of the S wave, and delayed nadir of S wave are strong predictors of VT.
“The presence of broad R wave, slurred or notched down stroke of the S wave, and delayed nadir of S wave are strong predictors of VT. 58”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [58]
Cites
Wellens, H. J. J., Bär, F. W. H. M., & Lie, K. I. (1978) · The American Journal of Medicine · doi:10.1016/0002-9343(78)90176-6 · Cited by 538 · see citing works
Wide Complex Tachycardia: Misdiagnosis and Outcome After Emergent Therapy
Stewart, R. B., BARDY, G. H., & GREENE, H. L. (1986) · Annals of Internal Medicine · doi:10.7326/0003-4819-104-6-766 · Cited by 259 · see citing works
Josephson, M. E., Horowitz, L. N., Waxman, H. L., et al. (1981) · Circulation · doi:10.1161/01.cir.64.2.257 · Cited by 164 · see citing works
Self-citationThe Differential Morphology of Anomalous Ventricular Complexes of RBBB-Type in Lead V 1
SANDLER, I. A., & MARRIOTR, H. J. L. (1965) · Circulation · doi:10.1161/01.cir.31.4.551 · Cited by 143 · see citing works
MISDIAGNOSIS OF CHRONIC RECURRENT VENTRICULAR TACHYCARDIA
Dancy, M. C., Camm, A. J., & Ward, D. E. (1985) · The Lancet · doi:10.1016/s0140-6736(85)90363-0 · Cited by 119 · see citing works
A Prevalent Misconception Regarding Wide-Complex Tachycardias
Morady, F. (1985) · JAMA · doi:10.1001/jama.1985.03360190096032 · Cited by 81 · see citing works
Fisch, C., Zipes, D. P., & McHenry, P. L. (1973) · Circulation · doi:10.1161/01.cir.48.4.714 · Cited by 77 · see citing works
Wellens, H. J. J., Bär, F. W. H. M., Vanagt, E. J., Brugada, P., & Farré, J. (1981) · Springer eBooks · doi:10.1007/978-94-009-8239-0_11 · Cited by 75 · see citing works
Differential diagnosis of supraventricular and ventricular tachycardia.
Hj, M. (1970) · PubMed · Cited by 67 · see citing works
What’s New in Electrocardiography
(1981) · Springer eBooks · doi:10.1007/978-94-009-8239-0 · Cited by 62 · see citing works
Kistin, A. D. (1966) · Progress in Cardiovascular Diseases · doi:10.1016/s0033-0620(66)80018-x · Cited by 56 · see citing works
The electrocardiogram 80 years after Einthoven
Wellens, H. J. J. (1986) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(86)80457-0 · Cited by 53 · see citing works
Experimental Production of Aberrant Ventricular Conduction in Man
Cohen, S. I., Lau, S. H., Haft, J. I., et al. (1967) · Circulation · doi:10.1161/01.cir.36.5.673 · Cited by 53 · see citing works
Differential Diagnosis of Supraventricular and Ventricular Tachycardia
Marriott, H. J. L. (2008) · Cardiology · doi:10.1159/000174602 · Cited by 35 · see citing works
Wellens, H. J. J. (1986) · Annals of Internal Medicine · doi:10.7326/0003-4819-104-6-879 · Cited by 30 · see citing works
Wellens, H. J. J., Brugada, P., & HEDDLE, W. F. (1984) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(84)80337-x · Cited by 11 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex
Brugada, P., Brugada, J., Mont, L., Smeets, J., & Andries, E. W. (1991) · Circulation · doi:10.1161/01.cir.83.5.1649 · Cited by 738 · see citing works
New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia
Vereckei, A., Duray, G., Szénási, G., Altemose, G. T., & Miller, J. M. (2008) · Heart Rhythm · doi:10.1016/j.hrthm.2007.09.020 · Cited by 280 · see citing works
Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., et al. (2017) · Europace · doi:10.1093/europace/euw301 · Cited by 188 · see citing works
Self-citationR-wave peak time at DII: a new criterion for differentiating between wide complex QRS tachycardias
Pava, L. F., Perafán, P., Badiel, M., Arango, J. J., Mont, L., Morillo, C. A., & Brugada, J. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2010.03.001 · Cited by 140 · see citing works
Diagnostic criteria of broad QRS complex tachycardia: decades of evolution
Alzand, B. S. N., & Crijns, H. J. G. M. (2011) · Europace · doi:10.1093/europace/euq430 · Cited by 93 · see citing works
Comparison of five electrocardiographic methods for differentiation of wide QRS-complex tachycardias
Jastrzebski, M., Kukla, P., Czarnecka, D., & Kawecka-Jaszcz, K. (2012) · EP Europace · doi:10.1093/europace/eus015 · Cited by 91 · see citing works
Steurer, G., Gürsoy, S., Frey, B., Simonis, F., Andries, E., Brugada, P., & Kuck, K. (1994) · Clinical Cardiology · doi:10.1002/clc.4960170606 · Cited by 53 · see citing works
Garner, J. B., Miller, J. M., Fellow, C. E., & Professor of Medicine and Director, C. C. E. A. T. P. (2013) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2013.2.1.23 · Cited by 38 · see citing works
CRIJNS, H. J. G. M., KINGMA, J. H., GOSSELINK, A. T. M., DALRYMPLE, H. W., De LANGEN, C. D. J., & LIE, K. (1993) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.1993.tb01283.x · Cited by 18 · see citing works
- Authors
- Kindwall, K. E., Brown, J., & Josephson, M. E.
- Affiliations
- Hospital of the University of Pennsylvania (US)
- Corresponding author
- Kindwall, K. Elizabeth
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1988-06
- Volume
- 61
- Issue
- 15
- Pages
- 1279-1283
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2102379385
- Cited by
- 253
- References
- 16
- Citations by year
- 2026: 2 · 2025: 17 · 2024: 4 · 2023: 8 · 2022: 9 · 2021: 10 · 2020: 11 · 2019: 12 · 2018: 9 · 2017: 14 · 2016: 2 · 2015: 8 · 2014: 7 · 2013: 11 · 2012: 3
- FWCI
- 6.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL-28093, HL 07346)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- ventricular tachycardia, wide complex tachycardia, left bundle branch block pattern, electrocardiographic criteria, supraventricular tachycardia with aberrancy, left axis deviation, myocardial infarction, sensitivity and specificity
- MeSH terms
- Bundle-Branch Block, Diagnosis, Differential, Electrocardiography, Electrodes, Evaluation Studies as Topic, Humans, Myocardial Infarction, Retrospective Studies, Tachycardia, Tachycardia, Supraventricular
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
