BACKGROUND: We assessed the specificity of wide QRS complex tachycardia (WCT) differentiating algorithms in patients with preexistent left bundle branch block (LBBB) and heart failure. METHODS: Three hundred fourteen patients with resynchronization devices were retrospectively screened. electrocardiograms with supraventricular LBBB rhythm were used as a surrogate for supraventricular tachycardia QRS morphology. The Pava lead II criterion, ventricular activation velocity ratio (Vi/Vt) ratio in V(2), Vereckei aVR, Brugada, Griffith, and Bayesian algorithms were investigated. RESULTS: The WCT algorithms had a lower specificity (33%-69%) in patients with LBBB than in general WCT populations. The Pava lead II criterion and Brugada algorithm had higher specificity than other algorithms (P < .05). Several of the single criteria (absence of an RS complex in V(1) through V(6), initial R wave in aVR, Vi/Vt < 1 in V(2)) had specificities of 92% to 99%. CONCLUSIONS: In patients with heart failure and LBBB, an electrocardiographic diagnosis of ventricular tachycardia should be based on selected, specific criteria rather than on WCT algorithms.
BACKGROUND: We assessed the specificity of wide QRS complex tachycardia (WCT) differentiating algorithms in patients with preexistent left bundle branch block (LBBB) and heart failure. METHODS: Three hundred fourteen patients with resynchronization devices were retrospectively screened. electrocardiograms with supraventricular LBBB rhythm were used as a surrogate for supraventricular tachycardia QRS morphology. The Pava lead II criterion, ventricular activation velocity ratio (Vi/Vt) ratio in V(2), Vereckei aVR, Brugada, Griffith, and Bayesian algorithms were investigated. RESULTS: The WCT algorithms had a lower specificity (33%-69%) in patients with LBBB than in general WCT populations. The Pava lead II criterion and Brugada algorithm had higher specificity than other algorithms (P < .05). Several of the single criteria (absence of an RS complex in V(1) through V(6), initial R wave in aVR, Vi/Vt < 1 in V(2)) had specificities of 92% to 99%. CONCLUSIONS: In patients with heart failure and LBBB, an electrocardiographic diagnosis of ventricular tachycardia should be based on selected, specific criteria rather than on WCT algorithms.
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
Authors: Anthony H Kashou; Christopher M Evenson; Peter A Noseworthy; Thoddi R Muralidharan; Christopher V DeSimone; Abhishek J Deshmukh; Samuel J Asirvatham; Adam M May Journal: Indian Heart J Date: 2020-09-23