1. Right bundle branch block-type wide QRS complex tachycardia with a reversed R/S complex in lead V 6 : Development and validation of electrocardiographic differentiation criteria.
- Author
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Kim M, Kwon CH, Lee JH, Hwang KW, Choi HO, Kim YG, Lee KN, Ahn J, Park HS, and Nam GB
- Subjects
- Bundle-Branch Block physiopathology, Diagnosis, Differential, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Tachycardia, Supraventricular physiopathology, Algorithms, Bundle-Branch Block diagnosis, Electrocardiography, Heart Rate physiology, Tachycardia, Supraventricular diagnosis
- Abstract
Background: Differentiation of supraventricular tachycardia (SVT) with a right bundle branch block (RBBB) pattern from ventricular tachycardia (VT) is difficult, particularly when the R/S ratio in lead V
6 is below 1.0., Objective: We sought to investigate the electrocardiographic criteria for distinguishing between these arrhythmias., Methods: We investigated electrocardiographic parameters from 111 consecutive patients who had RBBB pattern wide QRS complex tachycardia with a reversed R/S ratio in lead V6 (72 VTs, 39 SVTs). Diagnostic criteria from the previous algorithms were compared with our new criterion, the RS/QRS ratio, which was defined as the ratio of the interval from the onset of the QRS complex to the nadir of the S wave, divided by the QRS width in lead V6 . The RS/QRS ratio was further tested in a prospective population (31 fascicular VTs, 29 SVTs)., Results: The diagnostic accuracy of previous criteria (Brugada algorithm, Vereckei algorithm, and R-wave peak time criterion) was only modest. However, the RS/QRS ratio in lead V6 was significantly lower in SVT than in VT (0.36 ± 0.04 vs 0.50 ± 0.08; P < .001). A cutoff value of the RS/QRS ratio >0.41 differentiated VT from SVT with a high diagnostic accuracy (sensitivity 97.2%; specificity 89.7%). When tested in a prospective population with fascicular VT, the diagnostic accuracy of the criteria was maintained (sensitivity 90.3%; specificity 86.2%)., Conclusion: The RS/QRS ratio >0.41 in lead V6 is a simple and reliable index for distinguishing VT from SVT in RBBB pattern wide QRS complex tachycardia with a reversed R/S complex in lead V6 . This criterion was particularly useful for the differential diagnosis of fascicular VT from RBBB pattern SVT., (Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)- Published
- 2021
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