Cited by 280Cardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmiasECG Monitoring and Analysis

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New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia

Vereckei, András, Duray, Gábor, Szénási, Gábor, Altemose, Gregory T., Miller, John M.·2008·Heart Rhythm

DOI 10.1016/j.hrthm.2007.09.020

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Abstract

Background We recently reported an ECG algorithm for differential diagnosis of regular wide QRS complex tachycardias that was superior to the Brugada algorithm.Objective The purpose of this study was to further simplify the algorithm by omitting the complicated morphologic criteria and restricting the analysis to lead aVR.Methods In this study, 483 wide QRS complex tachycardias [351 ventricular tachycardias (VTs), 112 supraventricular tachycardias (SVTs), 20 preexcited tachycardias] from 313 patients with proven diagnoses were prospectively analyzed by two of the authors blinded to the diagnosis. Lead aVR was analyzed for (1) presence of an initial R wave, (2) width of an initial r or q wave >40 ms, (3) notching on the initial downstroke of a predominantly negative QRS complex, and (4) ventricular activation-velocity ratio (v(i)/v(t)), the vertical excursion (in millivolts) recorded during the initial (v(i)) and terminal (v(t)) 40 ms of the QRS complex. When any of criteria 1 to 3 was present, VT was diagnosed; when absent, the next criterion was analyzed. In step 4, v(i)/v(t) >1 suggested SVT, and v(i)/v(t) < or =1 suggested VT.Results The accuracy of the new aVR algorithm and our previous algorithm was superior to that of the Brugada algorithm (P = .002 and P = .007, respectively). The aVR algorithm and our previous algorithm had greater sensitivity (P <.001 and P = .001, respectively) and negative predictive value for diagnosing VT and greater specificity (P <.001 and P = .001, respectively) and positive predictive value for diagnosing SVT compared with the Brugada criteria.Conclusion The simplified aVR algorithm classified wide QRS complex tachycardias with the same accuracy as standard criteria and our previous algorithm and was superior to the Brugada algorithm.

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BackgroundMethodResultInfluential
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“Second, the diagnostic performance of automated models was not directly compared with traditional manual WCT differentiation approaches (Brugada et al., 1991; Chen et al., 2019; Jastrzebski et al., 2017; Pava et al., 2010; Vereckei et al., 2008).”
Method
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Background
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“The most helpful ECG findings indicating VT are the presence of capture and fusion beats, and AV dissociation.(1,2)”
Background
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Background
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“2 This reasoning, however, may be faulty, as it omits two issues: (1) the catecholamine sensitivity of both the AV conduction system and the accessory pathways (AP) and (2) the inability of most ECG methods for WCT diagnosis to differentiate between preexcitation and ventricular ectopy.”
T-wave reversal in the augmented unipolar right arm electrocardiographic lead is associated with increased risk of sudden death
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“as proximal left anterior descending (LAD) coronary disease [13] and diagnosis of ventricular tachycardia [14].”
Stress-induced cardiomyopathy accompanied by heat stroke
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Taquicardias supraventriculares. Estado del arte
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Authors: Vereckei, A., Duray, G., Szénási, G., Altemose, G. T., & Miller, J. M.
Affiliations: Semmelweis University (HU)
National Healthcare Service Center (HU)
Egis Pharmaceuticals (Hungary) (HU)
Mayo Clinic in Arizona (US)
Indiana University School of Medicine (US)
Corresponding author: Vereckei, András
ORCID: Vereckei, András
Duray, Gábor
Szénási, Gábor
Miller, John M.
Venue: Heart Rhythm
Publisher: Elsevier BV
Published: 2008-01
Volume: 5
Issue: 1
Pages: 89-98
ISSN: 1547-5271 (ISSN-L)
DOI: 10.1016/j.hrthm.2007.09.020
OpenAlex: W2135161353
Cited by: 280
References: 28
Citations by year: 2026: 7 · 2025: 9 · 2024: 23 · 2023: 15 · 2022: 16 · 2021: 17 · 2020: 27 · 2019: 23 · 2018: 16 · 2017: 27 · 2016: 13 · 2015: 20 · 2014: 11 · 2013: 13 · 2012: 14
FWCI: 3.98
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Heart Rhythm (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 › ECG Monitoring and Analysis
Keywords: wide QRS tachycardia, ventricular tachycardia, supraventricular tachycardia, lead aVR, ECG algorithm, QRS morphology, differential diagnosis
MeSH terms: Adult, Algorithms, Diagnosis, Differential, Electrocardiography, Electrodes, Female, Humans, Male, Tachycardia, Supraventricular, Tachycardia, Ventricular, Brugada Syndrome

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New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia

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