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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The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex
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Method
Can a new algorithm improve diagnostic accuracy in wide QRS complex tachycardia?
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A Breath-Taking Change
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“In the absence of pre-excitation, these criteria have been reported to have a > 90 % sensitivity and speci®city for diagnosing VT [1,2,3].”
BackgroundMethodInfluential
Wide QRS Complex Tachycardia: What is the Mechanism?
Morady, F., Wong, K.-L., Hanna, M., Kocovic, D. Z., & Pavri, B. B. (1998) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.1998.tb00891.x
Right Rhythm, Right Patient, Right Ventricle
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Wide QRS Complex Tachycardia in a Young Healthy Man
Ohe, T. (2011) · Journal of Arrhythmia · doi:10.1016/s1880-4276(11)80012-8
Transitory or permanent regular wide QRS complex tachycardia induced by atrial stimulation in patients without apparent heart disease. Significance
Brembilla-Perrot, B., Beurrier, D., Houriez, P., Claudon, O., Rizk, J., Lemoine, C., Gregoire, P., & Nippert, M. (2003) · Annales de Cardiologie et d Angéiologie · doi:10.1016/s0003-3928(03)00090-8
Ventricular Tachycardia Epitomizing a New Algorithm
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Supraventricular or ventricular tachycardia?
Lambiase, P. D. (2005) · British Journal of Hospital Medicine · doi:10.12968/hmed.2005.66.sup2.19716
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Diagnostic des tachycardies un pour un
Extramiana, F., MESSALI, A., Traullé, S., Halima, M. B., Maison‐Blanche, P., Denjoy, I., Jode, P. D., Kedra, A., & Leenhardt, A. (2010) · Archives of Cardiovascular Diseases Supplements · doi:10.1016/s1878-6480(10)70368-2
“Des critères et algorithmes ont été proposés pour différencier ces deux éventualités, les plus utilisés étant ceux proposés par Pedro Brugada [6].”
Background
A Wide QRS Tachycardia in a Young Patient: Does It Ring a Bell?
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“The QRS morphology in the precordial leads (q in V1, QS pattern in V3 and V4 and rS pattern in V5 and V6) as well as the QRS axis of −100° is consistent with a monomorphic ventricular tachycardia (VT), originating from the apico-postero-lateral wall of the left ventricle [1].”
Background
Emergency management of wide complex tachycardia
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“According to the criteria of Brugada, there are RS complexes in the precordial leads, the longest R-S interval is less than 100 ms, there is no AV dissociation and the classical criteria for ventricular tachycardia (VT) in the precordial leads are missing [2].”
Method
Differentialdiagnose einer regelmäßigen Tachykardie mit Linksschenkelblockartigem Kammerkomplex an Hand eines ungewöhnlichen Falles
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Result
An Interesting Case in Differential Diagnosis of wide-QRS Tachycardia —AV Reciprocating Tachycardia with Enhanced AV Nodal Conduction—
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Diagnóstico basado en evidencia
Sandoya, E. (2009) · Redalyc (Universidad Autónoma del Estado de México)
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Glancy, D. L., Wilklow, F. E., Lopez, C., Makkena, B., & Helmcke, F. (2008) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2008.11928365
“Proc (Bayl Univ Med Cent) 2008;21(1):75–76”
BackgroundMethodInfluential
Narrow QRS Complexes During Wide QRS Tachycardia: What Is the Mechanism
Vora, A. M., & Lokhandwala, Y. Y. (1998) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1998.tb01132.x
Lead aVR in wide QRS complex tachycardia—another window marker
Senthilkumaran, S., Meenakshisundaram, R., Benita, F., & Thirumalaikolundusubramanian, P. (2015) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2015.02.029
Protocolo diagnóstico de taquicardias con intervalo RR regular
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UTILIDAD Y RENDIMIENTO DE LOS ALGORITMOS DE BRUGADA Y VERECKEI-2 EN EL DIAGNÓSTICO DE LA TAQUICARDIA VENTRICULAR IDIOPÁTICA USEFULNESS AND PERFORMANCE OF THE BRUGADA AND VERECKEI-2 ALGORITHMS IN THE DIAGNOSIS OF IDIOPATHIC VENTRICULAR TACHYCARDIA
Puerta, R. C., González, E. C., Fábián, F., Ramírez, R. R., Peña, G. P., Elizundia, J. M. C., & León, A. R. (2012) · Dialnet (Universidad de la Rioja)
A new criterion to diagnose wide-complex tachycardia: The quest for a simple, efficient diagnostic marker
Assal, C., & Vijayaraman, P. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2010.03.025
Wearable Cardiac Detector
Harshitha, R., Manohar, M., Dhanya, P., Manoj, P., Swathi, S., Amogh, M., Talasila, V., Jamadagni, H. S., & Kumar, B. S. (2015) · Lecture notes in electrical engineering · doi:10.1007/978-81-322-2141-8_17
“This positioning is known as ‘Einthoven’s triangle’ [4].”
EKG-Klassifikation: Tachykardien
Dorwarth, U., Gerth, A., Haberl, R. L., Hoffmann, E., Näbauer, M., Reithmann, C., REMP, T., Steinbeck, G., & STEINBIGLER, P. (2000) · Springer eBooks · doi:10.1007/978-3-662-12156-6_24
The Investigation of the Patient with Palpitations
d’Ávila, A., Andries, E., & Brugada, P. (1994) · Springer eBooks · doi:10.1007/978-3-642-85068-4_27
Sistema de reconocimiento y diagnóstico de arritmias cardíacas aplicado a la identificación de taquicardias de complejos anchos a partir del ECG System for the recognition and diagnostics of cardiac arrhythmias applied to the identification of wide complex tachycardia from the ECG
Rodriguez, O. J. O., Sierra, D. A., & Rueda, O. L. (2009)
Taquicardia Ventricular Curável em Paciente com Miocardiopatia Isquêmica
Senn, F., Atié, I., de Siqueira, L. R., & Atié, J. (2011)
Antiarrhythmische Akuttherapie ventrikulärer Tachyarrhythmien
Wöhrle, J., Großmann, G., Hombach, V., & Kochs, M. (2003) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-003-0387-4
“Die Differentialdiagnose einer monomorphen Tachykardie mit breitem Kammerkomplex umfasst eine supraventrikuläre Tachykardie mit präexistentem oder funktionellem Schenkelblock (Aberranz), eine antidrome AV-Reentry-Tachykardie bei Präexzitationssyndrom oder eine ventrikuläre Tachykardie.”
BackgroundInfluential
Tools for Teaching Arrhythmias: Wide QRS Beats and Rhythms—Part II, QRS Morphology Clues
Jacobson, C. (2007) · AACN Advanced Critical Care · doi:10.4037/15597768-2007-1010
A tale of two tachycardias
Yeo, C., Chow, J., Leong, K., & Ho, K. (2015) · Singapore Medical Journal · doi:10.11622/smedj.2015014
“4).(3,4,7) In Vereckei et al’s algorithm,(7) diagnosis of VT is made when any one of criteria 1 to 3 is present.”
BackgroundMethodResultInfluential
Myocardial 99m-Tc tetrofosmin reverse redistribution as a possible marker of tissue at risk
Salerno, A., Fragasso, G., & Maranta, F. (2012) · The Anatolian Journal of Cardiology · doi:10.5152/akd.2013.048
Częstoskurcz nadkomorowy z szerokimi zespołami QRS i rozkojarzeniem przedsionkowo-komorowym — czy to możliwe? Supraventricular tachycardia with broad QRS complexes and atrioventricular dissociation — is that possible?
Kukla, P. (2013)
Management of Arrhythmic Patients in the Emergency Department: General Principles
Surian, A., & Visintin, L. (2015) · Springer eBooks · doi:10.1007/978-3-319-24328-3_1
Eletrocardiograma do Mês ECG apresentado pelo Serviço de Arritmias Cardíacas e Centro de Fibrilação Atrial do Hospital Pró-Cardíco, a convite do Grupo de Estudos em Eletrocardiografia da SOCERJ
Saad, E., Ferreira, C., Joaquim, P., Maldonado, S., Costa, I. P., Veronese, F. O., Eduardo, L., & Camanho, M. (2006)
Common Types of Supraventricular Tachycardia: Diagnosis and Management
Athens, O. (2010)
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“Neben dem Bild eines intermittierenden typischen LSB spricht das Fehlen der „harten“ Diagnose-Kriterien eindeutig gegen das Vorliegen einer ventrikulären Tachykardie [2].”
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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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