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

The DOI matches its Crossref record; 26 of the 28 references it cites were found in a registry or an index.

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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Crossref · 10.1016/j.hrthm.2007.09.020

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Metadata

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
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
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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