R-wave peak time at DII: a new criterion for differentiating between wide complex QRS tachycardias
Abstract
Background Differential diagnosis of wide QRS complex tachycardias using the 12-lead ECG may be difficult in many clinical settings.Objective The purpose of this study was to determine the value of ECG lead II, specifically, the duration at its beginning, defined as R-wave peak time (RWPT), in differentiating ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in patients with wide QRS complex tachycardia.Methods Two hundred eighteen ECGs showing wide QRS complex tachycardias were evaluated. Two cardiologists blinded to the diagnosis measured RWPT duration at lead II (from the isoelectric line to the point of first change in polarity), and results between VT and SVT were compared, with the findings of electrophysiologic study used as the gold standard.Results One hundred sixty-three VTs had a significantly longer RWPT at DII (76.7 +/- 21.7 ms vs 26.8 +/- 9.5 ms in 55 SVT, P = .00001). Receiver operating characteristic curve identified RWPT > or =50 ms at lead II as having greater specificity and sensitivity in discriminating VT from SVT. Area under the curve was 0.97 (95% confidence interval 0.95-0.99), positive likelihood ratio was 34.8, and kappa coefficient (kappa) was 0.86. Bivariate analysis identified higher age in VT patients (60.7 vs 50.1 years, P < or =.01) and wider QRS complex duration at lead II in VT patients (169.4 vs 128.3 ms, P <.0001). QRS width at DII was not superior to RWPT in diagnosing VT.Conclusion RWPT > or =50 ms at DII is a simple and highly sensitive criterion that discriminates VT from SVT in patients with wide QRS complex tachycardia.
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The R-wave peak time at lead II ≥50 ms, independent of whether the complex is positive or negative, has been reported to have a sensitivity of 93% and a specificity of 99% for identifying VT.
“The R-wave peak time (RWPT) at lead II ≥50 ms, independent of whether the complex is positive or negative, has been reported to have a sensitivity of 93%, and a specificity of 99%, for identifying VT (Figure 8), 61”
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 [61]
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- Authors
- Pava, L. F., Perafán, P., Badiel, M., Arango, J. J., Mont, L., Morillo, C. A., & Brugada, J.
- Affiliations
- Fundación Valle del Lili (CO)
- Population Health Research Institute (CA)
- Corresponding author
- Pava, Luis Fernando
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2010-07
- Volume
- 7
- Issue
- 7
- Pages
- 922-926
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2030379422
- Cited by
- 140
- References
- 20
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 10 · 2023: 11 · 2022: 11 · 2021: 12 · 2020: 14 · 2019: 11 · 2018: 7 · 2017: 14 · 2016: 8 · 2015: 7 · 2014: 6 · 2013: 8 · 2012: 5
- FWCI
- 3.69
- Type
- journal article
- Language
- en
- Open access
- closed
- 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, differential diagnosis, QRS duration, diagnostic accuracy
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Diagnosis, Differential, Electrocardiography, Female, Heart Conduction System, Humans, Male, Middle Aged, ROC Curve, Sensitivity and Specificity, Tachycardia, Supraventricular, Tachycardia, Ventricular, Young Adult
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