Abstract 11358: Assessment of Two Newly Proposed Algorithms for Differentiating Wide Complex Tachycardias Using Premature Ventricular Contractions
Background: Two new simplified algorithms for differentiating wide QRS complex tachycardias (WCT) have recently demonstrated higher sensitivity, specificity, and predictive values than the more cumbersome traditional Brugada criteria. However, to date the two new approaches have never been compared head to head, nor have they ever been directly compared to the traditional Brugada criteria.
Methods: One hundred Premature Ventricular Contractions (PVC) from 100 consecutive 12-lead electrocardiograms (ECG) were included in this study as the gold standard for an electrical complex arising from ventricular tissue. Each PVC was independently analyzed by two general cardiology fellows with respect to the two new WCT algorithms (the Simplified aVR approach [SAVR] and R-Wave Peak Time [RWPT] in Lead II approach) and the traditional Brugada criteria. Concordance between fellow interpretations was used to assess inter-observer agreement for each method, and the discordant interpretations were adjudicated by a senior electrophysiologist for the study's primary analysis, a head to head comparison of the two new WCT algorithms.
Results: Cardiology fellows identified the PVC as a ventricular beat on 179 of 200 (90%) interpretations using SAVR, 141/200 (71%) using RWPT, and 163/200 (82%) using the traditional Brugada criteria. For SAVR, RWPT, and Brugada, respectively, the joint probability of agreement between fellows was 0.83, 0.81, and 0.85, and the prevalence-adjusted bias-adjusted kappa was 0.66 (k=0.12), 0.62 (k=0.56), and 0.70 (k=0.51). After 3rd party adjudication, the overall sensitivity for SAVR was 93%, RWPT 74%, and the traditional Brugada criteria 84%.
Conclusions: SAVR is more sensitive than RWPT and traditional Brugada morphology criteria for identifying a PVC as an electrical complex arising from ventricular tissue. With inter-observer variability comparable to the more time-consuming Brugada approach, SAVR appears to be an excellent alternative for rapidly differentiating WCT on bedside ECG.
- © 2012 by American Heart Association, Inc.