Cited by 140Cardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmiasECG Monitoring and Analysis

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R-wave peak time at DII: A new criterion for differentiating between wide complex QRS tachycardias

Pava, Luis Fernando, Perafán, Pablo, Badiel, Marisol, Arango, Juan José, Mont, Lluis, Morillo, Carlos A., Brugada, Josep·2010·Heart Rhythm

DOI 10.1016/j.hrthm.2010.03.001

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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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Background
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Kashou, A. H., LoCoco, S., Gardner, M. R., Webb, J., Jentzer, J. C., Noseworthy, P. A., DeSimone, C. V., Deshmukh, A. J., Asirvatham, S. J., & May, A. M. (2023) · Annals of Noninvasive Electrocardiology · doi:10.1111/anec.13085 · Cited by 5
“…WCTs (Bru-gada et al., 1991; Chen et al., 2019; Griffith et al., 1994; Jastrzebski et al., 2016; Kindwall et al., 1988; Moccetti et al., 2022; Pava et al., 2010; Vereckei et al., 2008; Wellens et al., 1978), only recent works (Kashou, DeSimone, Deshmukh, et al., 2020; Kashou, Lo-Coco,…”
Confounding factors leading to misdiagnosing ventricular tachycardia as supraventricular in the emergency room
Farré, J., Campal, J. M. R., & Sternick, E. B. (2022) · Indian Pacing and Electrophysiology Journal · doi:10.1016/j.ipej.2022.11.002 · Cited by 4
An artificial intelligence–enabled Holter algorithm to identify patients with ventricular tachycardia by analysing their electrocardiogram during sinus rhythm
Gendelman, S., Zvuloni, E., Oster, J., Suleiman, M. A., Derman, R., & Behar, J. A. (2024) · European Heart Journal - Digital Health · doi:10.1093/ehjdh/ztae025 · Cited by 6
Case 4-2020: A 52-Year-Old Woman with Seizure Disorder and Wide-Complex Tachycardia
Kramer, D. B., Mihatov, N., Buch, K. A., Zafar, S. F., & Ruskin, J. N. (2020) · New England Journal of Medicine · doi:10.1056/nejmcpc1913471 · Cited by 4
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Why “don’t work” electrocardiographic algorithms for differential diagnostics of wide QRS tachycardia
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“Обилие существующих критериев и алгоритмов ДД ТШК как ставших «классическими» [7-9], так и «новых» [10-13], на наш взгляд, ставит врачей в весьма затруднительное положение.”
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Santos, F. J. D. S., Pisani, C. F., Darrieux, F., CIRINO, C. M. F., HACHUL, D. T., Santos, A. M., Pérez‐Riera, A. R., Barbosa‐Barros, R., & Scanavacca, M. (2021) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20190501 · Cited by 4
“Etapa 2 48,0 (43,5-52,5) 86,8 (81,8-90,9) 88,7 (84,3-92,3) 43,6 (39,0-48,3) 60,3 (56,7-63,9)”
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Budanova, M. A., Chmelevsky, M. P., Treshkur, T. V., & Тихоненко, В. М. (2021) · Journal of Arrhythmology · doi:10.35336/va-2020-4-24-32 · Cited by 3
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May, A. M., Katbamna, B. B., Shaikh, P. A., LoCoco, S., Deych, E., Zhou, R., Liu, L., Mikhova, K. M., Ghadban, R., Cuculich, P. S., et al. (2024) · Communications Medicine · doi:10.1038/s43856-024-00725-2 · Cited by 3
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Wide Complex Tachycardias
Alblaihed, L., & Al-Salamah, T. A. (2022) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2022.06.010 · Cited by 3
R-wave peak time at lead II in Chinese healthy adults
Deng, J., Chen, T., Zeng, C., Lu, N., Zhou, L., Tan, X., & Yu, M. (2016) · BMC Cardiovascular Disorders · doi:10.1186/s12872-016-0258-7 · Cited by 3
“[4] reported that RWPT at lead II in patients with SVT was significantly narrower than in patients with VT (26.”
MethodResult
Ventrikuläre Herzrhythmusstörungen
Duncker, D., Bauersachs, J. K., & Veltmann, C. (2017) · Der Internist · doi:10.1007/s00108-017-0341-x · Cited by 3
“„R-wave peak time“ in II QRS-Dauer vom Beginn der Depolarisation bis zum erstenWechsel der Polarität ≥50ms in Ableitung II spricht für VT [25]”
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Yusuf, J., Pandey, P. K., Mehta, V., & Mukhopadhyay, S. (2023) · Journal of Electrocardiology · doi:10.1016/j.jelectrocard.2023.03.003 · Cited by 3
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Miller, J. M., & Das, M. K. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-44733-1.00060-2 · Cited by 2
Utility of Inferior Lead Q-waveforms in diagnosing Ventricular Tachycardia
Subramany, S., Kattoor, A. J., Kovelamudi, S., Devabhaktuni, S. R., Mehta, J. L., Vallurupalli, S., Paydak, H., & Pothineni, N. V. K. (2020) · Clinical Medicine Insights Cardiology · doi:10.1177/1179546820953416 · Cited by 2
Differential Diagnosis of Supraventricular Tachycardia
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R-peak time: A novel marker of depolarization in patients with Human Immunodeficiency Virus
Çekirdekçi, E. İ., Evren, E. Ü., Evren, H., & Buğan, B. (2019) · Journal of Electrocardiology · doi:10.1016/j.jelectrocard.2019.05.016 · Cited by 2
Removing the complexity from wide complex tachycardia
Abualsuod, A. M., & Miller, J. M. (2021) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2021.04.001 · Cited by 2
Wide QRS Tachycardias Management in Emergency Departments: What Really Matters
de Alencar, J. N., de Carvalho, G. D., Campelo, R. T., Felicioni, S. P., Scheffer, M. K., & Marchi, M. F. N. D. (2024) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20230829i · Cited by 1
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Are Available Electrocardiographic Methods Accurate Enough to Diagnose Ventricular Tachycardia in the Emergency Department?
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Supraventricular tachycardia with broad QRS complexes and atrioventricular dissociation — is that possible?
Jastrzębski, M., & Kukla, P. (2013) · Kardiologia Polska · doi:10.5603/kp.2013.0103 · Cited by 1
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Tomasevic, M. V., Aleksandric, S. B., Rakočević, J., Miloradović, V., & Sreckovic, M. J. (2018) · Srpski arhiv za celokupno lekarstvo · doi:10.2298/sarh180108025t · Cited by 1
Wide QRS Complex Tachycardia Change to Narrow QRS Complex Tachycardia After β-Blocker Administration
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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
ORCID: Badiel, Marisol
Morillo, Carlos A.
Venue: Heart Rhythm
Publisher: Elsevier BV
Published: 2010-07
Volume: 7
Issue: 7
Pages: 922-926
ISSN: 1547-5271 (ISSN-L)
DOI: 10.1016/j.hrthm.2010.03.001
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
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, 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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R-wave peak time at DII: A new criterion for differentiating between wide complex QRS tachycardias

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