RESUMEN
BACKGROUND: The three-step Brugada group algorithm is the only published electrocardiographical (ECG) algorithm for differentiating ventricular tachycardia (VT) from pre-excited tachycardia (PXT) as a cause of regular wide QRS complex tachycardia (WCT). This study aimed to improve the diagnostic accuracy of the Brugada group algorithm. METHODS: This study modified the Brugada group algorithm by adding a new aVR lead criterion (initial positive deflection in lead aVR and the QRS complex area above the baseline is greater than the area below the baseline). The Brugada group algorithm and the new, modified four-step algorithm in 300 WCT ECGs (241 VTs, 59 PXTs) was applied. If any of the criteria were fulfilled, VT was diagnosed; if none were fulfilled, a diagnosis of PXT was established. RESULTS: The test accuracy, VT diagnosis sensitivity, and negative predictive value (NPV) of the new, modified algorithm were significantly greater than that of the Brugada group algorithm: test accuracy 220 of 300 (73%) vs 182 of 300 (61%); sensitivity 73% vs 55% (p<0.001 for both); NPV 40% vs 31% (p=0.0205). The VT diagnosis specificity of the Brugada group algorithm was greater than that of the new, modified algorithm (83% vs 75%; p=0.019). There was no significant difference between the new, modified and Brugada group algorithms in the positive predictive values (92% vs 93%, respectively) for a VT diagnosis, and positive and negative likelihood ratio values (2.87 vs 3.26; 0.36 vs 0.54, respectively). CONCLUSIONS: The new, modified algorithm proved to be more sensitive for the differentiation of VT from PXT than the Brugada group algorithm.
Asunto(s)
Taquicardia Supraventricular , Taquicardia Ventricular , Humanos , Taquicardia Supraventricular/diagnóstico , Diagnóstico Diferencial , Taquicardia Ventricular/diagnóstico , Ventrículos Cardíacos , Electrocardiografía , AlgoritmosRESUMEN
A 23-year-old gentleman presented with a history of palpitations. The 12-lead electrocardiogram showed no manifest ventricular pre-excitation. Echocardiogram was within normal limits. A retrograde study showed concentric activation of the atrium with decremental conduction. Atrial pacing from right atrial free wall showed progressive pre-excitation. No anterograde nodal duality was documented.
Asunto(s)
Fascículo Atrioventricular Accesorio , Nodo Atrioventricular/fisiopatología , Fascículo Atrioventricular/fisiopatología , Bloqueo de Rama/diagnóstico , Técnicas Electrofisiológicas Cardíacas , Síndromes de Preexcitación/diagnóstico , Periodo Refractario Electrofisiológico , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Potenciales de Acción , Bloqueo de Rama/fisiopatología , Frecuencia Cardíaca , Humanos , Masculino , Síndromes de Preexcitación/fisiopatología , Valor Predictivo de las Pruebas , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Factores de Tiempo , Adulto JovenAsunto(s)
Fascículo Atrioventricular Accesorio/fisiopatología , Bloqueo de Rama/fisiopatología , Frecuencia Cardíaca , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Técnicas de Ablación , Fascículo Atrioventricular Accesorio/cirugía , Potenciales de Acción , Bloqueo de Rama/diagnóstico , Estimulación Cardíaca Artificial , Técnicas Electrofisiológicas Cardíacas , Humanos , Masculino , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Factores de Tiempo , Adulto JovenRESUMEN
A 63-year-old gentleman presented to the emergency room (ER) with complaints of sudden onset of palpitation for the last 1 hour. He denied any presyncope or syncope. He was tachycardic with pulse rate of 120 beats per minute. His blood pressure was 110/70 mm Hg. A 12-lead electrocardiogram (ECG) was taken. What is the likely diagnosis?