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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MethodInfluential
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(2017) · Journal of Cardiology & Current Research · doi:10.15406/jccr.2017.08.00273 · Cited by 1
“The most commonly used algorithm is the so-called Brugada algorithm or Brugada criteria, in which the isolated presence of atrioventricular dissociation has specificity of 100% to support VT diagnosis [2] (Figure 1).”
Method
OBSOLETE: Ventricular Tachycardia in Ischemic and Dilated Cardiomyopathy: Mechanisms and Diagnosis
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Method
Approach to the wide QRS-complex tachycardia
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Background
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“(1)Algorithm to differentiate VT from SVT (Brugada Four-Step Algorithm [3]), analyze step by step according to ① ~ ④ , if it meets the criteria, it is preliminarily judged as VT, otherwise it is diagnosed as SVT. ① No RS shape in the precordial lead QRS complex.”
Zwei junge Patienten mit Vorhofflimmern und regelmäßiger Tachykardie
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“Some interesting phenomena occur before arrhythmia termination: (1) progressive slowing of the tachycardia, and (2) disappearance of LBBB aberrancy on the last beat of tachycardia.”
Background
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“100 ms’ criterion is borderline, and there are no clear signs of AV dissociation, so again the morphology criteria in V1-2 and V6 leads must be used, favouring the diagnosis of ventricular tachycardia.(2) However, a newer algorithm proposed by Vereckei et al.”
Method
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A very wide complex tachycardia
Kheiri, B., Vedantham, V., & Scheinman, M. M. (2023) · Heart Rhythm · doi:10.1016/j.hrthm.2022.08.030 · Cited by 1
Ablation of Ventricular Tachycardia in Coronary Artery Disease
Haqqani, H. M., & Callans, D. J. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-93110-6.00033-5 · Cited by 1
Analytical Study of an Arrhythmia
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Sistema de reconocimiento y diagnóstico de arritmias cardíacas aplicado a la identificación de taquicardias de complejos anchos a partir del ECG
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Active Ventricular Arrhythmias
de Luna, A. B. (2012) · Wiley eBooks · doi:10.1002/9781118392041.ch16 · Cited by 1
The Differential Diagnosis of Wide Complex Tachycardia—ED Diagnostic and Management Considerations
Charlton, N. P., & Brady, W. J. (2011) · doi:10.1002/9781119959809.ch8 · Cited by 1
The Approach to the Patient with a Wide Complex Tachycardia
Goldberger, Z. D., & Baman, T. S. (2013) · doi:10.1002/9781118484784.ch19 · Cited by 1
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Wide‐complex Tachycardia: Diagnostic Value of the Brugada Algorithm in Emergency Medicine
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QRS aberration during atrial fibrillation at rest and during exercise. Effect of a selective potassium channel blocking agent
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VT or Not VT?
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“Analysis of the wide QRS complex tachycardia on the 12-lead ECG demonstrated an RS complex and an R to S interval , 100 ms in all precordial leads, and there was no evidence of atrioventricular (AV) dissociation and morphology criteria in V1 or V6 favoring SVT.2 Furthermore, the QRS morphology during tachycardia resem…”
Background
Efficacy of Adenosine in Wide-Complex Tachycardia
Wyer, P. C. (1994) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(94)70335-3 · Cited by 1

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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