Еlectrocardiographic criteria and algorithms for differential diagnosis of wide QRS complexes arrhythmias
https://doi.org/10.35336/VA-2020-4-24-32
Abstract
Differential diagnosis of ventricular and supraventricular wide QRS complexes arrhythmias remains one of the most urgent and serious problems of modern cardiology. High-precision intracardiac and transesophageal electrophysiological examination cannot be widely used in routine clinical practice because of the complexity of using, the risk of complications, and the necessary of special equipment. The availability and simplicity of electrocardiogram registration was the reason for study and development of ECG criteria and algorithms for differential diagnosis. However, their low accuracy, variety, complexity and laboriousness of application often leads to diagnostic errors and low usage of clinicians.
About the Authors
M. A. Budanova
Almazov National Medical Research Centre
Russian Federation
Russian Federation
Margarita Budanova
Saint-Petersburg
M. P. Chmelevsky
Almazov National Medical Research Centre; Saint-Petersburg Electrotechnical University “LETI”
Russian Federation
Saint-Petersburg
Russian Federation
Saint-Petersburg
T. V. Treshkur
Almazov National Medical Research Centre
Russian Federation
Saint-Petersburg
Russian Federation
Saint-Petersburg
V. M. Tikhonenko
Scientific, Clinical and Educational Center “Cardiology” of Saint-Petersburg State University
Russian Federation
Russian Federation
References
1. Griffith MJ, Belder MA, Linker NJ, et al. Multivariate analysis to simplify the differential diagnosis of broad complex tachycardia. British Рeart Journal. 1991;66(2):166-74. DOI:10.1136/hrt.66.2.166.
2. Baenman JF, Morady F, DiCarlo LA, et al. Differentiation of ventricular from supraventricular tachycardia with aberration: Value of the clinical history. Ann Emerg Med. 1987;16(1): 403.
3. Stewart RB, Bardy GH, Greene HL. Wide complex tachycardia: misdiagnosis and outcome after emergent therapy. Annals of Internal Medicine. 1986;104(6): 766-71.
4. McGovern B, Garan H, Ruskin JN. Precipitation of cardiac arrest by verapamil in patients with Wolff-Parkinson- White syndrome. Ann Intern Med. 1986;104(6): 791-4.
5. Brugada P, Brugada J, Mont L, et al. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991;83(5): 1649-59. DOI:10.1161/01.cir.83.5.1649.
6. Jastrzebski M, Sasaki K, Kukla P, et al. The ventricular tachycardia score: A novel approach to electrocardiographic diagnosis of ventricular tachycardia. Europace. 2016;18(4): 578-84. DOI:10.1093/europace/euv118.
7. Dancy M, Ward D. Diagnosis of ventricular tachycardia: A clinical algorithm. British Medical Journal (Clinical research ed.). 1985;291(6501): 1036-8. DOI:10.1136/bmj.291.6501.1036.
8. Wellens HJ, Brugada P. Diagnosis of ventricular tachycardia from the 12-lead electrocardiogram. Cardiology Clinics. 1987;5(3): 511-25.
9. Drew BJ, Scheinman MM. Value of electrocardiographic leads MCL1, MCL6 and other selected leads in the diagnosis of wide QRS complex tachycardia. Journal of the American College of Cardiology. 1991;18(4): 1025-33. DOI:10.1016/0735-1097(91)90762-X.
10. Drew BJ, Scheinman MM. ECG criteria to distinguish between aberrantly conducted supraventricular tachycardia and ventricular tachycardia: Practical aspects for the immediate care setting. Pacing and Clinical Electrophysiology: PACE. 1995;18: 2194-208. DOI:10.1111/j.1540-8159.1995.tb04647.x.
11. Vereckei A, Duray G, Szénási G, et al. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm. 2008;5(1): 89-98. DOI:10.1016/j.hrthm.2007.09.020.
12. Wellens HJ, Bär FW, Lie KI. The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. The American Journal of Medicine. 1978;64(1): 27-33. DOI:10.1016/0002-9343(78)90176-6.
13. Wellens HJ, Barr FW, Vanagt EJ, et al. The Differentiation between Ventricular Tachycardia and Supraventricular Tachycardia with Aberrant Conduction: The Value of the 12-Lead Electrocardiogram. In. What’s New in Electrocardiography (Ed. Wellens HJJ, Kulbertus HE) 1981:184-199.
14. Marriott HJ. Differential diagnosis of supraventricular and ventricular tachycardia. Cardiology. 1990;77(3): 209-20. DOI:10.1159/000174602.
15. Alberca T, Almendral J, Sanz P, et al. Evaluation of the specificity of morphological electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardia in patients with intraventricular conduction defects. Circulation. 1997;96(10): 3527-33.
16. Coumel P, Leclercq JF, Attuel P, et al. 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(10):792-805. DOI: 10.1093/oxfordjournals.eurheartj.a061568.
17. Miller JM, Das MK, Arora R, et al. Differential diagnosis of wide QRS complex tachycardia. In. Cardiac Electrophysiology. From Cell to Bedside (Ed Zipes DP, Jalife J). 2004:747-757.
18. Kindwall KE, Brown J, Josephson ME. Electrocardiographic criteria for ventricular tachycardia in wide complex left bundle branch block morphology tachycardias. The American Journal of Cardiology. 1988;61(15):1279-83. doi:10.1016/0002-9149(88)91169-1.
19. Volders PG, Timmermans C, Rodriguez LM, et al. Wide QRS complex tachycardia with negative precordial concordance: always a ventricular origin? J Cardiovasc Electrophysiol. 2003;14: 109-11.
20. Sandler IA, Marriott HJ. The differential morphology of anomalous ventricular complexes of RBBB-type in lead V1; Ventricular ectopy versus aberration. Circulation. 1965;31: 551-6. DOI:10.1161/01.cir.31.4.551.
21. Dongas J, Lehmann MH, Mahmud R, et al. The value of pre-existing bundle branch block in the electrocardiographic differentiation of supraventricular from ventricular origin of wide complex tachycardia. Am J Cardiol. 1985;55: 717-21.
22. Guo H, Hecker S, Lévy S, et al. Ventricular tachycardia with QRS configuration similar to that in sinus rhythm and a myocardial origin: differential diagnosis with bundle branch reentry. Europace. 2001;3(2): 115-23.
23. Miller JM, Das MK, Yadav AV, et al. Value of the 12- Lead ECG in Wide QRS Tachycardia. Cardiology Clinics. 2006;24(3): 439-451.
24. Vereckei A, Duray G, Szénási G, et al. Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia. European Heart Journal. 2007;28(5): 589-600. DOI:10.1093/eurheartj/ehl473.
25. Pava LF, Perafan P, Badiel M, et al. R-wave peak time at DII: A new criterion for differentiating between wide complex QRS tachycardias. Heart Rhythm. 2010;7(7):922-6. DOI: 10.1016/j.hrthm.2010.03.001.
26. Datino T, Almendral J, Avila P, et al. Specificity of electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardia in patients with intraventricular conduction defect. Heart Rhythm. 2013;10(9):1393-401. DOI: 10.1016/j.hrthm.2013.07.006.
27. Andrade FR, Eslami M, Elias J, et al. Diagnostic clues from the surface ECG to identify idiopathic (fascicular) ventricular tachycardia: Correlation with electrophysiologic findings. Journal of Cardiovascular Electrophysiology. 1996;7(1): 2-8. DOI:10.1111/j.1540-8167.1996.tb00454.x.
28. Isenhour JL, Craig S, Gibbs M, et al. Wide-complex tachycardia: continued evaluation of diagnostic criteria. Acad Emerg Med. 2000;7(7): 769-73.
29. Herbert ME, Votey SR, Morgan MT, et al. Failure to agree on the electrocardiographic diagnosis of ventricular tachycardia. Ann Emerg Med. 1996;27(1): 35-8.
30. Steurer G, Gürsoy S, Frey B, et al. The differential diagnosis on the electrocardiogram between ventricular tachycardia and preexcited tachycardia. Clin Cardiol. 1994;17(6): 306-8.
31. Podrid P, Kowey P. Handbook of cardiac arrhythmia. Baltimore: Williams and Wilkins. 1996: 459.
32. Lau EW, Pathamanathan RK, Ng GA, et al. The Bayesian approach improves the electrocardiographic diagnosis of broad complex tachycardia. Pacing and Clinical Electrophysiology: PACE. 2000;23: 1519-26.
33. Griffith MJ, Belder MA, Linker NJ, et al. Difficulties in the use of electrocardiographic criteria for the differential diagnosis of left bundle branch block pattern tachycardia in patients with a structurally normal heart. European Heart Journal. 1992;13(4): 478-83. DOI:10.1093/oxfordjournals.eurheartj.a060200.
34. Wijnmaalen AP, Stevenson WG, Schalij MJ, et al. ECG identification of scar-related ventricular tachycardia with a left bundle-branch block configuration. Circulation. Arrhythmia and Electrophysiology. 2011;4(4): 486-93. DOI:10.1161/CIRCEP.110.959338.
35. Crijns HJ, van Gelder IC, Lie KI. Supraventricular tachycardia mimicking ventricular tachycardia during flecainide treatment. Am J Cardiol. 1988;62(17): 1303-6.
36. Le Davay M, Victor J, Dupuis JM, et al. Tachycardies à QRS larges: Limites des critères électrocardiographiques chez les patients sous antiarythmiques. Ann Cardiol Angéiol. 1994;43: 253-255.
37. Revishvili AS, Ardashev AV, Boytsov SA. VNOA. Clinical guidelines for electrophysiological studies, catheter ablation and the use of implantable antiarrhythmic devices // M.: New edition. 2013: 596. (In Russ.)].
38. Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-executive summary. J Am Coll Cardiol. 2003;42(8): 1493-1531. DOI:10.1016/j.jacc.2003.08.013.
39. Shlevkov NB, Salami KF, Kiktev VG, et al. New ECG criteria for differential diagnosis of wide QRS complex tachycardias with right bundle branch block pattern. Therapeutic Archive. 2019; 91 (4):83-89 (In Russ.)
40. Salami HF, Shlevkov NB, Novikov PS, et al. New Electrocardiographic Criteria for Differential Diagnosis of Tachycardias with Advanced QRS Complexes According to the Type of Blockade of Left Bundle of His. The Siberian Medical Journal. 2019;34(1): 98-106 (In Russ.). DOI:10.29001/2073-8552-2019-34-1-98-106.
41. Lebedev DS. Wide complex QRS tachycardia (Differential diagnosis, management). Journal of Arrhthmology. 1998;7: 65-73 (In Russ.).]
42. Medvedev MM, Parizhskiy AB. Why “don’t work” electrocardiographic algorithms for differential diagnostics of wide QRS tachycardia. Journal of Arrhythmology. 2020;27(2):54-66 (In Russ.)] DOI: 10.35336/VA-2020-2-54-66
43. Medvedev MM. Differential diagnosis of tachycardia with wide QRS complexes: from «classical» signs to the first algorithm. Journal of Arrhythmology. 2019;26(3): 48-56(In Russ.) DOI: 10.35336/VA-2019-3-48-56.
44. Katritsis DG, Brugada J. Differential Diagnosis of Wide QRS Tachycardias. Arrhythmia & Electrophysiology Review. 2020;9(3): 155-60. DOI: 10.15420/aer.2020.20.
45. Brugada J, Katritsis DG, Arbelo, E at al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. European Heart Journal. 2019;00:1-66.
46. Budanova MA, Chmelevsky MP, Treshkur TV et al. Automatic detection of ventricular and supraventricular wide QRS arrhythmias using complex of morphological criteria and algorithms. Kardiologiia. 2019;59(3S): 36-42 (In Russ.)].
Review
For citations:
Budanova M.A., Chmelevsky M.P., Treshkur T.V., Tikhonenko V.M. Еlectrocardiographic criteria and algorithms for differential diagnosis of wide QRS complexes arrhythmias. Journal of Arrhythmology. 2020;27(4):24-32. (In Russ.) https://doi.org/10.35336/VA-2020-4-24-32
Views:
701
Email this article 