BACKGROUND: Differential diagnosis of wide QRS complex tachycardias using the 12-lead ECG may be difficult in many clinical settings. OBJECTIVE: The purpose of this study was to determine the value of ECG lead II, specifically, the duration at its beginning, defined as R-wave peak time (RWPT), in differentiating ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in patients with wide QRS complex tachycardia. METHODS: Two hundred eighteen ECGs showing wide QRS complex tachycardias were evaluated. Two cardiologists blinded to the diagnosis measured RWPT duration at lead II (from the isoelectric line to the point of first change in polarity), and results between VT and SVT were compared, with the findings of electrophysiologic study used as the gold standard. RESULTS: One hundred sixty-three VTs had a significantly longer RWPT at DII (76.7 +/- 21.7 ms vs 26.8 +/- 9.5 ms in 55 SVT, P = .00001). Receiver operating characteristic curve identified RWPT > or =50 ms at lead II as having greater specificity and sensitivity in discriminating VT from SVT. Area under the curve was 0.97 (95% confidence interval 0.95-0.99), positive likelihood ratio was 34.8, and kappa coefficient (kappa) was 0.86. Bivariate analysis identified higher age in VT patients (60.7 vs 50.1 years, P < or =.01) and wider QRS complex duration at lead II in VT patients (169.4 vs 128.3 ms, P <.0001). QRS width at DII was not superior to RWPT in diagnosing VT. CONCLUSION: RWPT > or =50 ms at DII is a simple and highly sensitive criterion that discriminates VT from SVT in patients with wide QRS complex tachycardia. Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
BACKGROUND: Differential diagnosis of wide QRS complex tachycardias using the 12-lead ECG may be difficult in many clinical settings. OBJECTIVE: The purpose of this study was to determine the value of ECG lead II, specifically, the duration at its beginning, defined as R-wave peak time (RWPT), in differentiating ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in patients with wide QRS complex tachycardia. METHODS: Two hundred eighteen ECGs showing wide QRS complex tachycardias were evaluated. Two cardiologists blinded to the diagnosis measured RWPT duration at lead II (from the isoelectric line to the point of first change in polarity), and results between VT and SVT were compared, with the findings of electrophysiologic study used as the gold standard. RESULTS: One hundred sixty-three VTs had a significantly longer RWPT at DII (76.7 +/- 21.7 ms vs 26.8 +/- 9.5 ms in 55 SVT, P = .00001). Receiver operating characteristic curve identified RWPT > or =50 ms at lead II as having greater specificity and sensitivity in discriminating VT from SVT. Area under the curve was 0.97 (95% confidence interval 0.95-0.99), positive likelihood ratio was 34.8, and kappa coefficient (kappa) was 0.86. Bivariate analysis identified higher age in VTpatients (60.7 vs 50.1 years, P < or =.01) and wider QRS complex duration at lead II in VTpatients (169.4 vs 128.3 ms, P <.0001). QRS width at DII was not superior to RWPT in diagnosing VT. CONCLUSION: RWPT > or =50 ms at DII is a simple and highly sensitive criterion that discriminates VT from SVT in patients with wide QRS complex tachycardia. Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Authors: Demosthenes G Katritsis; Giuseppe Boriani; Francisco G Cosio; Pierre Jais; Gerhard Hindricks; Mark E Josephson; Roberto Keegan; Bradley P Knight; Karl-Heinz Kuck; Deirdre A Lane; Gregory Yh Lip; Helena Malmborg; Hakan Oral; Carlo Pappone; Sakis Themistoclakis; Kathryn A Wood; Kim Young-Hoon; Carina Blomström Lundqvist Journal: Arrhythm Electrophysiol Rev Date: 2016
Authors: Andrés Ricardo Pérez-Riera; Luiz Carlos de Abreu; Raimundo Barbosa-Barros; Kjell C Nikus; Adrian Baranchuk Journal: Ann Noninvasive Electrocardiol Date: 2015-11-02 Impact factor: 1.468
Authors: Anthony H Kashou; Peter A Noseworthy; Christopher V DeSimone; Abhishek J Deshmukh; Samuel J Asirvatham; Adam M May Journal: J Am Heart Assoc Date: 2020-05-19 Impact factor: 5.501