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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Further improvement of classical criteria for differentiation of wide-QRS tachycardia in SVT and VT using artificial neural network techniques
Dassen, W. R. M., Mulleneers, R. G. A., den Dulk, K., Karthaus, V., Talmon, J. L., & Wellens, H. J. J. (2002) · Computers in cardiology · doi:10.1109/cic.1993.378435 · Cited by 3
Adenosine for diagnosis of wide QRS tachycardia: Rapid infusion for an easier conclusion*
Trohman, R. G. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181abfb9f · Cited by 3
Tachykardie mit breitem QRS-Komplex bei einem jungen Mann
WEISMÜLLER, P., Kattenbeck, K., Brandts, B., & Trappe, H. (2000) · Der Internist · doi:10.1007/s001080050685 · Cited by 3
“Das Oberflächen-EKG kann oft Hinweise auf die supraventrikuläre oder ventrikuläre Genese der Tachykardie geben [2], was in unserem Fall jedoch nicht gelang.”
Background
Ockham’s Razor and Bayes Theorem at Work
Brugada, P. (2022) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2022.04.006 · Cited by 3
QRS complex configurations in 12-lead electrocardiograms of dogs with monomorphic ventricular tachycardia or complete bundle branch block
Perego, M., Maffei, A., Cavallini, D., & Santilli, R. A. (2025) · Frontiers in Veterinary Science · doi:10.3389/fvets.2025.1579951 · Cited by 2
Identification of atrio-ventricular relationship with echocardiography—A useful tool to diagnose ventricular tachycardia
Jacobsen, P. K., Modi, S. S., McCarty, D., Klein, G. J., & Leong‐Sit, P. (2012) · Resuscitation · doi:10.1016/j.resuscitation.2012.07.037 · Cited by 2
Differential Diagnosis of Narrow and Wide Complex Tachycardias
Miller, J. M., & Das, M. K. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-44733-1.00060-2 · Cited by 2
Wide QRS tachycardia associated with multiple accessory pathways in a patient with Wolff–Parkinson–White syndrome
Nakamura, T., Kanda, G., Sasaki, Y., Noda, R., Hiranuma, N., Sumimoto, K., & Fujii, T. (2019) · Journal of Cardiology Cases · doi:10.1016/j.jccase.2019.04.003 · Cited by 2
Integrating Electrocardiography and Vectorcardiography in the Differential Diagnosis of Wide Complex Tachycardia in a Patient with Left Ventricular Noncompaction: A Case Report and Brief Literature Review
Țentea, C.-P., Apetrei, C.-A., Lazar, R.-D., Zehan, I.-G., Paștiu, G., Porca, A., Jelnean, M., Pop, S., & Blendea, D. C. (2021) · Diagnostics · doi:10.3390/diagnostics11071152 · Cited by 2
“The two most established sets of criteria that help with the differential diagnosis of a WCT are included in the Brugada [16] and Vereckei [17] algorithms.”
BackgroundMethodResult
An unusual site of ablation for a ventricular tachycardia
Ghosh, A., Sekar, A., Saravanan, S., Sriram, C. S., & Pandurangi, U. M. (2023) · Journal of Arrhythmia · doi:10.1002/joa3.12954 · Cited by 2
Neue notfallmedizinische Trends in der EKG-Diagnostik – Arrhythmie, Ischämie und plötzlicher Herztod
Grautoff, S., Fessele, K., Bastian, D., & Knappen, N. (2024) · Notfall + Rettungsmedizin · doi:10.1007/s10049-024-01292-8 · Cited by 2
An extremely wide QRS complex tachycardia induced by anamorelin
Shimojo, K., Kanzaki, Y., Miyazawa, H., & Morishima, I. (2024) · Journal of Arrhythmia · doi:10.1002/joa3.13072 · Cited by 2
Anti-Arrhythmic Drugs and Cardiac Resuscitation
Olshansky, B., Nerheim, P., & Kerber, R. E. (2005) · Humana Press eBooks · doi:10.1385/1-59259-814-5:351 · Cited by 2
Intraoperative interfascicular ventricular tachycardia: A rare occurrence
Ramachandran, R., Rewari, V., Parakh, N., Singh, P. M., & Jayanandan, S. (2014) · Indian Journal of Anaesthesia · doi:10.4103/0019-5049.126807 · Cited by 2
“Over the years some algorithms have been developed which make the diagnosis of WCT more scientific and straightforward.[6,7] There are some simpler signs for identifying VT e.”
Method
Irregular wide QRS complex tachycardia in a patient with pulmonary hypertension: What is the mechanism?
Te, A. L. D., Chung, F., Lin, Y., & Chen, S.-A. (2015) · HeartRhythm Case Reports · doi:10.1016/j.hrcr.2015.10.003 · Cited by 2
Wide-QRS Complex Tachycardia
Hanna, E. B., Johnson, C. J., & Glancy, D. L. (2017) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2017.09.035 · Cited by 2
“(1) There is atrioventricular dissociation.”
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
“17 As per this algorithm, VT is diagnosed in the presence of at least 1 of the following: (1) monophasic R wave in lead aVR; (2) predominantly negative QRS in leads I, II, and III and (3) opposing QRS complex in the limb leads (OQL): concordant monophasic QRS in all 3 inferior leads and concordant monophasic QRS in 2…”
Method
Differenzialdiagnostik der Breitkomplex-Tachykardie
Deneke, T., Mügge, A., Kerber, S., Nentwich, K., Fochler, F., Müller, P., Grewe, P., & Halbfaß, P. (2015) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-015-0387-1 · Cited by 2
Sine-wave pattern on the electrocardiogram and hyperkalaemia
Scarabeo, V., Baccillieri, S., Marco, A. D., de Conti, F., Contessotto, F., & Piovesana, P. (2007) · Journal of Cardiovascular Medicine · doi:10.2459/01.jcm.0000285314.23530.87 · Cited by 2
Tachycardia in ebstein’s anomaly
Nikolić, G. (2003) · Heart & Lung · doi:10.1016/s0147-9563(03)00119-5 · Cited by 2
Electrocardiogram With a Twist
Lim, W., Chiamvimonvat, N., & Amsterdam, E. A. (2012) · Critical Pathways in Cardiology A Journal of Evidence-Based Medicine · doi:10.1097/hpc.0b013e318266e687 · Cited by 2
Modification of ventricular tachycardia by carotid sinus massage
Kappos, K. G., Koulizakis, N. G., & TOUTOUZAS, P. K. (1996) · Journal of Electrocardiology · doi:10.1016/s0022-0736(96)80097-5 · Cited by 2
Ventricular tachycardia, diagnosis and misdiagnosis: A case report
Symanski, B. J., & Marriott, H. J. L. (1995) · Heart & Lung · doi:10.1016/s0147-9563(05)80006-8 · Cited by 2

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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