The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex
Abstract
To determine the value of the electrocardiogram for differentiating aberrant conduction from ventricular ectopy, findings were retrospectively reviewed from patients with a widened QRS complex during tachycardia in whom the site of origin of tachycardia was determined by His bundle electrography. Seventy episodes of sustained ventricular tachycardia from 62 patients and 70 episodes of aberrant conduction during supraventricular tachycardia from 60 patients were available for study. Findings suggesting a ventricular origin of tachycardia were (1) QRS width over 0.14 sec, (2) left axis deviation, (3) certain configurational characteristics of QRS and (4) atrioventricular (A-V) dissociation. Capture or fusion beats resulting from A-V conduction of dissociated atrial complexes during ventricular tachycardia were seen during only four of 33 episodes of sustained tachycardia.
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In true LBBB, no Q wave is present in the lateral precordial leads; therefore, the presence of any Q or QS wave in lead V6 favours VT.
“In true LBBB, no Q wave is present in the lateral precordial leads.Therefore, the presence of any Q or QS wave in lead V6 favours VT. 56”
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 [56]
A RBBB morphology with a R:S ratio in V6 of less than 1 is seen rarely in SVT with aberrancy, mainly when the patient has a left axis deviation during sinus rhythm.
“A RBBB morphology with a R:S ratio in V 6 of less than 1 is seen rarely in SVT with aberrancy, mainly when the patient has a left axis deviation during sinus rhythm.56”
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 [56]
Predominantly negative QRS complexes in leads I, II, and III are a useful criterion for identifying VT.
“Thus, predominantly negative QRS complexes in leads I, II, and III are a useful criterion for identifying VT.”
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 [56]
Extreme left axis deviation (axis from -90° to +180°) strongly suggests VT both in the presence of RBBB and LBBB patterns.
“In particular, extreme left axis deviation (axis from 2908 to +1808) strongly suggests VT both in the presence of RBBB and LBBB patterns.56”
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 [56]
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References 18 · Cited by 538
- Authors
- Wellens, H. J. J., Bär, F. W. H. M., & Lie, K. I.
- Affiliations
- University of Amsterdam (NL)
- ORCID
- Lie, K.I.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 1978-01
- Volume
- 64
- Issue
- 1
- Pages
- 27-33
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2012925882
- Cited by
- 538
- References
- 18
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 10 · 2023: 9 · 2022: 10 · 2021: 18 · 2020: 17 · 2019: 11 · 2018: 16 · 2017: 23 · 2016: 4 · 2015: 9 · 2014: 12 · 2013: 13 · 2012: 15
- FWCI
- 10.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- 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
- electrocardiogram, differential diagnosis, tachycardia, ventricular tachycardia, supraventricular tachycardia with aberrancy, His bundle electrography, atrioventricular dissociation, fusion beats, left axis deviation
- MeSH terms
- Adolescent, Adult, Aged, Bundle-Branch Block, Child, Diagnosis, Differential, Electrocardiography, Female, Heart Atria, Heart Conduction System, Heart Rate, Heart Ventricles, Humans, Male, Middle Aged, Tachycardia
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