Cited by 738Cardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmiasECG Monitoring and Analysis

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A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex

Brugada, P, Brugada, J, Mont, L, Smeets, J, Andries, E W·1991·Circulation

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Abstract

BACKGROUND: In the differential diagnosis of a tachycardia with a wide QRS complex (greater than or equal to 0.12 second) diagnostic mistakes are frequent. Therefore, we investigated the reasons for failure of presently available criteria, and we identified new, simpler criteria and incorporated them in a stepwise approach that provides better sensitivity and specificity for making a correct diagnosis. METHODS AND RESULTS: A prospective analysis revealed that current criteria had a poor specificity for the differential diagnosis. The value of four new criteria incorporated in a stepwise approach was prospectively analyzed in a total of 554 tachycardias with a widened QRS complex (384 ventricular and 170 supraventricular). The sensitivity of the four consecutive steps was 0.987, and the specificity was 0.965. CONCLUSIONS: Current criteria for the differential diagnosis between supraventricular tachycardia with aberrant conduction and ventricular tachycardia are frequently absent or suggest the wrong diagnosis. The absence of an RS complex in all precordial leads is easily recognizable and highly specific for the diagnosis of ventricular tachycardia. When an RS complex is present in one or more precordial leads, an RS interval of more than 100 msec is highly specific for ventricular tachycardia. This new stepwise approach may prevent diagnostic mistakes.

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Background
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MethodInfluential
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Self-citation
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MethodInfluential
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“to be 100% associated with VT.(20) Our own review of 100 cases (personal observations) showed no significant advantage of this feature over the V1-V2 morphology criteria (see below), but the Brugada ‘‘precordial RS absent’’ has significant practical utility when analyzing an ECG.”
Background
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“In doing so, we: (1) review hallmark wide complex tachycardia differentiation criteria, (2) examine the conceptual and structural design of standard wide complex tachycardia differentiation methods, (3) discuss practical limitations of manually applied ECG interpretation approaches, and (4) highlight recently formulat…”
BackgroundMethodInfluential
Wide QRS complex tachycardia: ECG differential diagnosis
Brady, W. J., & Skiles, J. (1999) · The American Journal of Emergency Medicine · doi:10.1016/s0735-6757(99)90091-8 · Cited by 45
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“seen on the ECG waveform and is used for computing the heart rate and several heart-disease states [37], [38].”
Method
Diagnostic Clues From the Surfaee ECG to Identify Idiopathic (Fascicular) Ventricular Tachycardia: Correlation with Electrophysiologic Findings
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Wide complex tachycardia—ventricular tachycardia or not ventricular tachycardia, that remains the question
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Diagnosis and Management of Idiopathic Ventricular Tachycardia
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Antidromic tachycardia utilizing decremental, latent accessory atrioventricular fibers: Differentiation from adenosine-sensitive ventricular tachycardia
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Amiodarone Is Poorly Effective for the Acute Termination of Ventricular Tachycardia
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BackgroundInfluential
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“Brugada algorithm criteria (lack of an RS complex in leads V1–V6; presence of an RS interval > 100 ms; atrioventricular (AV) dissociation, presence of VT morphologic criteria in both V1 and V6) (Brugada et al., 1991).”
BackgroundMethod
Ventricular Arrhythmias
Schleifer, J. W., & Srivathsan, K. S. (2013) · Cardiology Clinics · doi:10.1016/j.ccl.2013.07.007 · Cited by 22
Specificity of electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardia in patients with intraventricular conduction defect
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The differential diagnosis of wide QRS complex tachycardia
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“In addition, RBBB morphologic changes in lead V1, the so-called “rabbit ear” configuration, are used to describe the double peak (RR′ wave) of the QRS complex; a larger amplitude initial peak (Rr′ wave) is suggestive of VT whereas a taller secondary peak (rR′ wave) is seen with SVT-AC [15, 16,17,18,19,20,21,22].”
BackgroundMethodInfluential
The VT Prediction Model: A simplified means to differentiate wide complex tachycardias
May, A. M., DeSimone, C. V., Kashou, A. H., Sridhar, H., Hodge, D. O., Carter, R. E., Lin, G., Asirvatham, S. J., Noseworthy, P. A., & Deshmukh, A. J. (2019) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.14321 · Cited by 21
“The VT Prediction Modelʼs diagnostic performance was not directly compared with conventional WCT differentiation methods.(5-9,18) Further research providing a direct head‐to‐head comparison between the VT Prediction Model versus manual ECG interpretation approaches is warranted.”
Method
Cardiac Rhythm Disturbances
Manrique, C. R., Tiwari, N., & Plana, J. C. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-802509-3.00013-3 · Cited by 20

Authors: Brugada, P., Brugada, J., Mont, L., Smeets, J., & Andries, E. W.
Affiliations: Onze Lieve Vrouwziekenhuis Hospital (BE)
ORCID: Brugada, P
Brugada, J
Mont, L
Andries, E W
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1991-05
Volume: 83
Issue: 5
Pages: 1649-1659
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.83.5.1649
OpenAlex: W2026083345
Cited by: 738
References: 7
Citations by year: 2026: 20 · 2025: 63 · 2024: 32 · 2023: 32 · 2022: 32 · 2021: 26 · 2020: 42 · 2019: 30 · 2018: 22 · 2017: 44 · 2016: 20 · 2015: 26 · 2014: 21 · 2013: 31 · 2012: 22
FWCI: 6.95
Type: journal article
Language: en
Open access: closed
Locations: Circulation (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, differential diagnosis, ventricular tachycardia, supraventricular tachycardia with aberrancy, precordial leads, diagnostic criteria, sensitivity and specificity
MeSH terms: Diagnosis, Differential, Electrocardiography, Humans, Prospective Studies, Sensitivity and Specificity, Tachycardia

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A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex

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