Journal of electrocardiology · 2011
Specificity of the wide QRS complex tachycardia algorithms in recipients of cardiac resynchronization therapy.
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Jastrzebski Marek, Kukla Piotr, Czarnecka Danuta, Kawecka-Jaszcz Kalina
Аннотация
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.
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.