Abstract 16158: A Novel Integrated Electrocardiographic Algorithm for Differentiation of Regular Wide QRS Complex Tachycardia
Background: The differentiation of regular, wide QRS-complex tachycardia (WCT) into ventricular tachycardia (VT) or supraventricular tachycardia with aberrant conduction (SVT-AC) is an important distinction to be made in the clinical setting. Currently available algorithms are complicated and rely on a high level of interpreter expertise. We sought to create a simple and easily applicable algorithm.
Methods: We constructed an algorithm including clinical and simple electrocardiographic criteria, avoiding morphology-based criteria. We retrospectively analyzed patients with sustained regular WCT who underwent an electrophysiology study (EPS). The diagnosis established on EPS was considered the gold standard. Our proposed algorithm comprises 3 steps. The first is structural heart disease, satisfied if the patient has a history of coronary artery disease (CAD), a left ventricular ejection fraction (LVEF) <35%, or an ICD/CRT/LVAD. The second and third are fulfilled if the duration from the beginning of the QRS complex to the first positive or negative peak is >40ms (1 mm at a sweep speed of 25 mm/s) in leads II and AVR. If ≥2/3 criteria are satisfied, a diagnosis of VT is established.
Results: We analyzed 200 WCT ECGs. 148 (74%) were VT and 52 (26%) were SVT-AC as determined by EPS. The etiologies of VT were ischemic - 92/148 (62.2%), non-ischemic - 32/148 (21.6%)% and idiopathic - 24/148 (16.2%). SVTs comprised AVRT/AVNRT - 22/52 (42.3%), atrial flutter - 21/52 (40.4%), atrial tachycardia - 7/52 (14.5%) and others - 2/52 (3.8%). The SN of the algorithm in our cohort was 90%, with a SP of 89%.
Conclusions: This novel algorithm integrating clinical data and 2 simple ECG criteria allows for excellent discrimination of regular WCTs. We believe its simplicity would allow for rapid differentiation especially by less experienced providers. Further validation in an independent patient cohort is warranted.
Author Disclosures: F. Moccetti: None. M. Yadava: None. N. Pavlovic: None. S. Knecht: None. A. Mühl: None. M. Kühne: None. B. Schär: None. B. Kaufmann: None. S. Osswald: None. C. Henrikson: None. C. Sticherling: None. T. Reichlin: None.
- © 2016 by American Heart Association, Inc.