European Heart Journal Advance Access published online on February 1, 2007
European Heart Journal, doi:10.1093/eurheartj/ehl473
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Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia
1 Third Department of Medicine, Semmelweis University, School of Medicine, Budapest, Kútvölgyi út 4, Hungary 1125
2 National Healthcare Center, Cardiovascular Center, Budapest, Hungary
3 EGIS Pharmaceuticals PLC, Budapest, Hungary
4 Mayo Clinic, Scottsdale, AZ, USA
5 Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
Received 13 March 2006; revised 19 November 2006; accepted 21 December 2006.
* Corresponding author. Tel: +36 1 325 1100 extn 7108 or 7233 or 7280; fax: +36 1 225 0196. E-mail address: vereckei{at}kut.sote.hu
AIMS: The Brugada criteria proposed to distinguish between regular, monomorphic wide QRS complex tachycardias (WCT) caused by supraventricular (SVT) and ventricular tachycardia (VT) have been reported to have a better sensitivity and specificity than the traditional criteria. By incorporating two new criteria, a new, simplified algorithm was devised and compared with the Brugada criteria.
METHODS AND RESULTS: A total of 453 WCTs (331 VTs, 105 SVTs, 17 pre-excited tachycardias) from 287 consecutive patients with a proven electrophysiological (EP) diagnosis were prospectively analysed by two of the authors blinded to the EP diagnosis. The following criteria were analysed: (i) presence of AV dissociation; (ii) presence of an initial R wave in lead aVR; (iii) whether the morphology of the WCT correspond to bundle branch or fascicular block; (iv) estimation of initial (vi) and terminal (vt) ventricular activation velocity ratio (vi/vt) by measuring the voltage change on the ECG tracing during the initial 40 ms (vi) and the terminal 40 ms (vt) of the same bi- or multiphasic QRS complex. A vi/vt >1 was suggestive of SVT and a vi/vt 
1 of VT. An initial R wave in lead aVR suggested VT. The overall test accuracy of the new algorithm was superior (P = 0.006) to that of the Brugada criteria. The new algorithm had a greater sensitivity (P < 0.001) and (–) predictive value (NPV) for VT diagnosis, and specificity (P = 0.0471) and (+) predictive value (PPV) for SVT diagnosis than those of the Brugada criteria [both NPV for VT diagnosis and PPV for SVT diagnosis were: 83.5% (95% confidence interval = CI 75.9–91.1%) for the new vs. 65.2% (95% CI 56.5–73.9%) for the Brugada algorithms].
CONCLUSION: The new algorithm is a highly accurate tool for correctly diagnosing the cause of WCT ECGs.
Key Words: Wide QRS complex tachycardia • Brugada criteria • Ventricular tachycardia • Supraventricular tachycardia
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  R. Dendi and M. E. Josephson A new algorithm in the differential diagnosis of wide complex tachycardia Eur. Heart J., March 1, 2007; 28(5): 525 - 526. [Full Text] [PDF]
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