TY - JOUR
T1 - Simplified Integrated Clinical and Electrocardiographic Algorithm for Differentiation of Wide QRS Complex Tachycardia
T2 - The Basel Algorithm
AU - Moccetti, Federico
AU - Yadava, Mrinal
AU - Latifi, Yllka
AU - Strebel, Ivo
AU - Pavlovic, Nikola
AU - Knecht, Sven
AU - Asatryan, Babken
AU - Schaer, Beat
AU - Kühne, Michael
AU - Henrikson, Charles A.
AU - Stephan, Frank Peter
AU - Osswald, Stefan
AU - Sticherling, Christian
AU - Reichlin, Tobias
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/7
Y1 - 2022/7
N2 - Background: Prompt differential diagnosis of wide QRS complex tachycardia (WCT) is crucial to patient management. However, distinguishing ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with wide QRS complexes remains problematic, especially for nonelectrophysiologists. Objectives: This study aimed to develop a simple-to-use algorithm with integration of clinical and electrocardiographic (ECG) parameters for the differential diagnosis of WCT. Methods: The 12-lead ECGs of 206 monomorphic WCTs (153 VT, 53 SVT) with electrophysiology-confirmed diagnoses were analyzed. In the novel Basel algorithm, VT was diagnosed in the presence of at least 2 of the following criteria: 1) clinical high risk features; 2) lead II time to first peak >40 ms; and 3) lead aVR time to first peak >40 ms. The algorithm was externally validated in 203 consecutive WCT cases (151 VT, 52 SVT). Its' diagnostic performance and clinical applicability were compared with those of the Brugada and Vereckei algorithms. Results: The Basel algorithm showed a sensitivity, specificity, and accuracy of 92%, 89%, and 91%, respectively, in the derivation cohort and 93%, 90%, and 93%, respectively, in the validation cohort. There were no significant differences in the performance characteristics between the 3 algorithms. The evaluation of the clinical applicability of the Basel algorithm showed similar diagnostic accuracy compared with the Brugada algorithm (80% vs 81%; P = 1.00), but superiority compared with the Vereckei algorithm (72%; P = 0.03). The Basel algorithm, however, enabled a faster diagnosis (median 36 seconds vs 105 seconds for the Brugada algorithm [P = 0.002] and 50 seconds for the Vereckei algorithm [P = 0.02]). Conclusions: The novel Basel algorithm based on simple clinical and ECG criteria allows for a rapid and accurate differential diagnosis of WCT.
AB - Background: Prompt differential diagnosis of wide QRS complex tachycardia (WCT) is crucial to patient management. However, distinguishing ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with wide QRS complexes remains problematic, especially for nonelectrophysiologists. Objectives: This study aimed to develop a simple-to-use algorithm with integration of clinical and electrocardiographic (ECG) parameters for the differential diagnosis of WCT. Methods: The 12-lead ECGs of 206 monomorphic WCTs (153 VT, 53 SVT) with electrophysiology-confirmed diagnoses were analyzed. In the novel Basel algorithm, VT was diagnosed in the presence of at least 2 of the following criteria: 1) clinical high risk features; 2) lead II time to first peak >40 ms; and 3) lead aVR time to first peak >40 ms. The algorithm was externally validated in 203 consecutive WCT cases (151 VT, 52 SVT). Its' diagnostic performance and clinical applicability were compared with those of the Brugada and Vereckei algorithms. Results: The Basel algorithm showed a sensitivity, specificity, and accuracy of 92%, 89%, and 91%, respectively, in the derivation cohort and 93%, 90%, and 93%, respectively, in the validation cohort. There were no significant differences in the performance characteristics between the 3 algorithms. The evaluation of the clinical applicability of the Basel algorithm showed similar diagnostic accuracy compared with the Brugada algorithm (80% vs 81%; P = 1.00), but superiority compared with the Vereckei algorithm (72%; P = 0.03). The Basel algorithm, however, enabled a faster diagnosis (median 36 seconds vs 105 seconds for the Brugada algorithm [P = 0.002] and 50 seconds for the Vereckei algorithm [P = 0.02]). Conclusions: The novel Basel algorithm based on simple clinical and ECG criteria allows for a rapid and accurate differential diagnosis of WCT.
KW - ECG
KW - algorithm
KW - cardiac arrhythmia
KW - sudden cardiac death
KW - supraventricular tachycardia
KW - ventricular tachycardia
KW - wide QRS complex tachycardia
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U2 - 10.1016/j.jacep.2022.03.017
DO - 10.1016/j.jacep.2022.03.017
M3 - Article
C2 - 35863808
AN - SCOPUS:85134162995
SN - 2405-500X
VL - 8
SP - 831
EP - 839
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 7
ER -