New ECG criteria for differential diagnosis of wide QRS complex tachycardias with right bundle branch block pattern

Abstract


Aim. To evaluate standard 12-lead ECG indices for the differential diagnosis of wide QRS tachycardias with right bundle branch block (RBBB) pattern. Materials and methods. Study analyses the 244 ECG indices in 111 patients (79 males and 32 females, age 53±17 years) with RBBB tachycardias, who underwent electrophysiological studies. First step includes retrospective analysis of QRS characteristics in 20 patients with ventricular tachycardias (VT), 24 pts with aberrant supraventricular tachycardias (SVT+RBBB) and 14 pts with antidromic SVTs (WPW). ROC- and multifactorial analyses were performed to develop diagnostic ECG algorithms. The prognostic accuracy of the algorithms was subsequently evaluated on a prospective group of patients with RBBB tachycardias (n=53). Results and discussion. ECG criteria of RBBB VTs were: 1) the presence Q-wave in lead II, 2) the duration interval R(peak)-S(end) >100 ms in lead V5. ECG criteria for antidromic SVTs with RBBB were: 1) the duration of the R wave in lead I ≥80 ms, 2) the absence of split (M-sharp) R-waves in lead V2, 3) the absence notch in ascending S wave in lead aVL. The accuracy of the algorhythm for diagnostic of VTs with RBBB was 83% (sensitivity 100%, specificity 73%). The accuracy of the algorhythm for diagnostic of antidromic SVTs with RBBB was 91% (sensitivity 85%, specificity 96%). Conclusion. The proposed algorithms are based on new ECG criteria for the differential diagnosis of wide QRS complexes tachycardias with RBBB pattern, unlike the previous algorithms.

Full Text

Restricted Access

About the authors

N B Shlevkov

A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology of the Ministry of Health of Russian Federation

Email: nik.shlevkov@inbox.ru
Moscow, Russia

H F Salami

A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology of the Ministry of Health of Russian Federation

Moscow, Russia

V G Kiktev

A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology of the Ministry of Health of Russian Federation

Moscow, Russia

S F Sokolov

A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology of the Ministry of Health of Russian Federation

Moscow, Russia

References

  1. Coumel P, Leclercq J.F, Attuel P, Maison B.P. The QRS morphology in post myocardial infarction ventricular tachycardia. A study of 100 tracings compared with 70 cases of idiopathic ventricular tachycardia. Eur Heart J. 1984;5:792-805.
  2. Kindwall K.E, Brown J, Josephson M.E. Electrocardiographic criteria for ventricular tachycardia in wide complex left bundle branch block morphology tachycardias. Am J Cardiol. 1988;61:1279-83.
  3. Brugada P, Brugada J, Mont L, Smeets J, Andries E.W.I. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991;83:1649-51.
  4. Wellens H.J. Electrophysiology: ventricular tachycardia: diagnosis of broad QRS сomplex tachycardia. Heart. 2001;86:579-85.
  5. Vereckei A, Duray G, Szenasi G, Altemose G.T, Miller J.M. Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia. Eur Heart J. 2007;28:589-600. doi: 10.1093/eurheartj/ehl473
  6. Datino T, Almendral J, Avila A.P, Torrecilla E.G, Atienza F, Arenal A. Specificity of electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardia in patients with intraventricular conduction defect. Heart Rhythm. 2013;10:1393-401. doi: 10.1016/j.hrthm.2013.07.006
  7. Oreto G, Luzza F, Satullo G, Donato A, Carbone V, Calabrò M.P. Wide QRS complex tachycardia: an old and new problem. G Ital Cardiol. 2009;10:580-95.
  8. Josephson M.B, Zimetbaum P. The tachyarrhythmias. Ed. by D.L Kasper, K Brauwald, A Fauci, et al. Harrison’s Principle of Internal Medicine 16th ed. New York: McGiaw-Hill; 2004.
  9. Jastrzebski M, Sasaki K, Kukla P, Fijorek K. The ventricular tachycardia score: a novel approach to electrocardiographic diagnosis of ventricular tachycardia. Europace. 2016;8:578-84. doi: 10.1093/europace/euv118
  10. Drew B.J, Scheinman M.M. ECG Criteria to Distinguish Between Aberrantly Conducted Supraventricular Tachycardia and Ventricular Tachycardia: Practical Aspects for the Immediate Care Seetting. PACE. 1995;18:2194-208.
  11. Griffith M, de Belder M.A, Linker N.J, Ward D.E, Camm A.J. Difficulties in the use of electrocardiographic criteria for the differential diagnosis of left bundle branch block pattern tachycardia in patients with structurally normal heart. Eur Heart J. 1992;13:478-83.
  12. Sousa P.A, Pereira S, Candeias R, de Jesus I. The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia. Rev Port Cardiol. 2014;33:165-73. doi: 10.1016/j.repc.2013.07.016
  13. Wellens H.J.J, Brugada P. Diagnosis of ventricular tachycardia from the twelve lead electrocardiogram. Cardiol Clin. 1987;5:511-26.
  14. Vereckei A, Duray G, Szénási G, Altemose G.T, Miller J.M. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm. 2008;5:89-98. doi: 10.1016/j.hrthm.2007.09.020
  15. AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2018;25;138:e415-e418. doi: 10.1161/CIR.0000000000000615
  16. Long B, Koyfman A. Best Clinical Practice: Emergency Medicine Management of Stable Monomorphic Ventricular Tachycardia. J Emerg Med. 2017;5:484-92. doi: 10.1016/j.jemermed.2016.09.010
  17. Задионченко В.С., Шехян Г.Г., Щикота А.М., Ялымов А.А. Дифференциальная диагностика «широких» тахикардий. Русский медицинский журнал. 2012;14:734.
  18. Buxton A.E, Marchlinski F.E, Doherty J.U, Flores B, Josephson M.E. Hazards of intravenous verapamil for sustained ventricular tachycardia. Am J Cardiol. 1987;59:1107-10.
  19. Garrаtt C, Antoniou A, Ward E, et al. Misuse of verapamil in pre - excited atrial fibrillation. Lancet. 1989;1;367-9.
  20. Gulamhusein S, Ko P, Klein G.J, et al. Ventricular fibrillation following verapamil in the Wolff-Parkinson-White syndrome. Am Heart J. 1982;106:145-7.
  21. Tchou P.J, Jazayeri M, Avitall B, et al. Wide QRS tachycardias: machanisms, differential diagnosis and acute management. Ed by G.V Naccarelli. Cardiac Arrhythmias: A Practical Approach. Mount Kisco, NY: Futura Publishing; 1991. P. 217-41.
  22. Казаков С.А., Рачок С.М., Руцкая Т.А. и др. Диффференциальная диагностика тахикардий с широким комплексом QRS. Часть 1. Традиционные и новые критерии дифференциальной диагностики желудочковых и суправентрикулярных тахикардий. Здравоохранение. 2016;(1):56-9.
  23. Eckardt L, Deneke T. Updated ESC guideline: innovations for the treatment of ventricular arrhythmias and recommendations for prevention of sudden cardiac death. Herzschrittmacherther Elektrophysiology. 2016;27:94-288. doi: 10.1007/s00399-016-0446-2
  24. Лебедев Д.С. Тахикардии с широкими комплексами QRS [Дифференциальный диагноз, лечебная тактика). Вестник аритмологии. 1998;(7):65-73.
  25. Wang P.J, Friedman P.L. "Clockwise" and "counterclockwise" bundle branch reentry as mechanism for sustained ventricular tachycardia masquerading as supraventricular tachycardia. PACE. 1989;12;1426-32.

Statistics

Views

Abstract - 32

PDF (Russian) - 14

Cited-By


PlumX

Dimensions

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Novoslobodskaya str 31c4., Moscow, 127005, Russian Federation

Managing Editor:

 

© 2018 "Consilium Medicum" Publishing house

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies