The ventricular tachycardia score: a novel approach to electrocardiographic diagnosis of ventricular tachycardia.

Electrocardiographic diagnosis of wide QRS complex tachycardia (WCT) continues to be challenging as none one of the available methods is specific for ventricular tachycardia (VT) diagnosis. We aimed to construct a method for WCT differentiation based on a scoring system, in which ECGs are graded according to the number of VT-specific features. This novel method was validated and compared with Brugada algorithm and other methods. A total of 786 WCTs (512 VTs) from 587 consecutive patients with a proven diagnosis were analysed by two blinded observers. The VT score method was based on seven ECG features: initial R wave in V1, initial r > 40 ms in V1/V2, notched S in V1, initial R in aVR, lead II R wave peak time ≥50 ms, no RS in V1-V6, and atrioventricular dissociation. Atrioventricular dissociation was assigned two points, and each of the other features was assigned one point. The overall accuracy of VT score ≥1 for VT diagnosis (83%) was higher than that of the aVR (72%, P = 0.001) and Brugada (81%) algorithms. Ventricular tachycardia score ≥3 was present in 66% of VTs and was more specific (99.6%) than any other algorithm/criterion for VT diagnosis. Ventricular tachycardia score ≥4 was present in 33% of VTs and was 100% specific for VT. The new ECG-based method provides a certain diagnosis of VT in the majority of patients with VT, identifies unequivocal ECGs, and has superior overall diagnostic accuracy to other ECG methods.

Jastrzebski M ，Sasaki K ，Kukla P ，Fijorek K ，Stec S ，Czarnecka D ... -  《-》

Ventricular tachycardia score - A novel method for wide QRS complex tachycardia differentiation - Explained.

Philosophy, merits and limitations of a novel method for wide QRS complex tachycardia differentiation, based on a scoring system and called the ventricular tachycardia (VT) score, were explained. The following criteria were assigned one point: initial dominant R wave in V1; initial r>40 ms in V1 or V2; notched S in V1; initial R wave in aVR; lead II RWPT≥50 ms; and absence of an RS in leads V1-V6. Atrioventricular dissociation (including fusion/capture beats and partial dissociation) was assigned two points. We recommend ≥3 VT score points for a firm diagnosis of VT. A cut-off ≥1 point can be used for diagnosis of VT when highest overall accuracy rather than error-free diagnosis is desired. However, in case of VT score of 0-2 (i.e., not fully diagnostic ECG), we recommend using other options (electrophysiological study, clinical data, previous and following ECGs, etc.) for confirming the diagnosis.

Jastrzębski M ，Kukla P ，Czarnecka D 《-》

Direct Comparison of Methods to Differentiate Wide Complex Tachycardias: Novel Automated Algorithms Versus Manual ECG Interpretation Approaches.

LoCoco S ，Kashou AH ，Deshmukh AJ ，Asirvatham SJ ，DeSimone CV ，Mikhova KM ，Sodhi SS ，Cuculich PS ，Ghadban R ，Cooper DH ，Maddox TM ，Noseworthy PA ，May AM ... -  《-》

[Value of aVR lead four steps algorithm on differential diagnosis of wide QRS complex tachycardia].

The aVR lead four steps is a new algorithm for differential diagnosis of wide QRS complex tachycardia (WCT). The study explores the clinical value of this new algorithm on differential diagnosis of WCT. Application of aVR lead four steps to analysis the electrocardiogram of patients with WCT proved by electrophysiological study. Every step's accuracy rate, sensitivity and specificity to differential diagnosis of ventricular tachycardia (VT) were calculated. The first step diagnosed VT according to presence of an initial R wave in the aVR lead. The second step diagnosed VT according to width of an initial r or q wave > 40 ms in the aVR lead. The third step diagnosed VT according to notching on the initial downstroke of a predominantly negative QRS complex in the aVR lead. The fourth step diagnosis VT according to ventricular activation-velocity ratio (Vi/Vt) in the aVR lead, Vi/Vt ≤ 1 suggested VT. Results derived from aVR lead four steps algorithm were compared with results derived from Brugada and Vereckei four steps algorithm. A total of 113 patients with WCT were analyzed (31 supraventricular tachycardia, SVT and 82 ventricular tachycardia, VT). The accuracy rate of differential diagnosis VT is 91.2%, sensitivity is 90.2% and specificity is 77.4%. The accuracy and sensitivity of the aVR lead four steps algorithm for differential diagnosis of WCT were superior to the Brugada Vereckei four steps algorithm (P < 0.05). The specificity of the Vereckei four steps algorithm was superior to aVR lead and Brugada four steps algorithm (P < 0.05), while the specificity of the aVR lead four steps algorithm was similar as Brugada four steps algorithm (P > 0.05). The aVR lead four steps algorithm is associated with excellent accuracy rate, sensitivity for differential diagnosis of WCT. This algorithm is simple and could be easily learned and applied by physician.

Lin T ，Ma YT ，Muhu Y ，Tang BP ，Hou YM ，Zhang YY ... -  《-》

Differential diagnosis of wide QRS tachycardias: comparison of two electrocardiographic algorithms.

This study's aim is to compare the ability of two ECG criteria to differentiate ventricular (VT) from supraventricular tachycardia (SVT): Brugada et al. [horizontal plane (HP) leads] and Vereckei et al. [frontal plane (FP), specifically aVR lead], having electrophysiological study (EPS) as gold standard. After comparing, suggestions for better diagnosis of wide QRS-complex tachycardia (WCT) in emergency situations were made. Fifty-one consecutive patients with 12-lead ECG registered during EPS-induced regular WCT were selected. Each ECG was split into two parts: HP (V1-V6) and FP (D1-D3, aVR, aVL, and aVF), randomly distributed to three observers, blinded for EPS diagnosis and complementary ECG plane, resulting in total 306 ECG analyses. Observers followed the four steps of both algorithms, counting time-to-diagnosis. Global sensitivity, specificity, percentage of incorrect diagnoses, and step-by-step positive/negative likelihood ratios (+LR and -LR) were calculated. Kaplan-Meier curve was plotted for final time-to-diagnosis. Inter-observer agreement was assessed with kappa-statistic. Global sensitivity was similarly high in FP and HP algorithms (89.2 vs. 90.1%), and incorrect classifications were 27.4 vs. 24.7%. Forty-eight correct analyses by Vereckei criteria took 9.13 s to diagnose VT in the first step, showing that first step was fast, with high +LR, generating nearly conclusive pre- (72.6%) to post-test (98.0%) changes for VT probability. Both algorithms as a whole are similar for diagnosis of WTC; however, the first step of Vereckei (initial R in aVR) is a simple, reproducible, accurate, and fast tool to use. The negativity of this step requires a 'holistic' approach to distinguish VT from SVT.

Kaiser E ，Darrieux FC ，Barbosa SA ，Grinberg R ，Assis-Carmo A ，Sousa JC ，Hachul D ，Pisani CF ，Kosa E ，Pastore CA ，Scanavacca MI ... -  《-》