Diagnostic criteria of broad QRS complex tachycardia: decades of evolution
Open accessAbstract
Broad QRS complex tachycardia still presents a diagnostic challenge when confronted with a 12-lead electrocardiogram (ECG). The ECG differential diagnosis includes ventricular tachycardia vs. supraventricular tachycardia with functional aberration, pre-existing bundle branch block, intraventricular conduction disturbances, or pre-excitation. Despite all available criteria, broad complex tachycardias are still misdiagnosed or remain undiagnosed. This paper will briefly review the most recognized criteria.
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This pattern suggests VT with a specificity of more than 90%, but this criterion has low sensitivity being present in <20% of all VTs.
“This pattern suggests VT with a specificity of more than 90%, but this criterion has low sensitivity being present in ,20% of all VTs.”
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 [53]
Conditions such as myocardial infarction, congestive heart failure, and recent angina pectoris favour VT in the differential diagnosis of wide-QRS tachycardia.
“Differential diagnosis should always be considered in the context of the underlying disease, with conditions such as myocardial infarction, congestive heart failure, and recent angina pectoris favouring VT. 53”
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 [53]
Positive concordance may occur during antidromic SVT using a left posterior or left lateral accessory pathway, but a negative concordance is nearly always VT.
“While positive concordance may occur during antidromic SVT using a left posterior or left lateral accessory pathway a negative concordance is nearly always VT. 53”
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 [53]
Wide-QRS tachycardias can be ventricular tachycardias, supraventricular tachycardias conducting with bundle-branch block aberration, or over an accessory pathway, with a reported proportion of 80%, 15% and 5%, respectively.
“Wide-QRS tachycardias can be ventricular tachycardias, and supraventricular tachycardias conducting with bundle-branch block aberration, or over an accessory pathway, with a reported proportion of 80%, 15% and 5%, respectively (Figure 4).53”
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 [53]
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- Authors
- Alzand, B. S. N., & Crijns, H. J. G. M.
- Affiliations
- Maastricht University Medical Centre (NL)
- Corresponding author
- Alzand, B. S. N.
- Crijns, H. J. G. M.
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-12-03
- Volume
- 13
- Issue
- 4
- Pages
- 465-472
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2103635564
- Cited by
- 93
- References
- 48
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 3 · 2023: 12 · 2022: 9 · 2021: 9 · 2020: 6 · 2019: 6 · 2018: 5 · 2017: 7 · 2016: 6 · 2015: 6 · 2014: 5 · 2013: 3 · 2012: 5
- FWCI
- 0.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- 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
- diagnostic criteria, ventricular tachycardia, supraventricular tachycardia with aberrancy, bundle branch block, intraventricular conduction disorders, preexcitation, misdiagnosis, 12-lead ECG
- MeSH terms
- Algorithms, Bundle-Branch Block, Diagnosis, Differential, Electrocardiography, Humans, Tachycardia, Tachycardia, Supraventricular, Tachycardia, Ventricular
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