Wide QRS tachycardias: the rationale behind electrocardiographic diagnostic criteria
Keywords:
Tachycardia, Diagnosis, CriteriaAbstract
Wide QRS tachycardias represent one of the most challenging scenarios in the interpretation of the electrocardiogram, even among experienced professionals or specialists. The various existing diagnostic criteria are essential tools for the correct identification of the origin of tachycardia, however, the knowledge of the electrophysiological principles of cardiac depolarization is fundamental to understand them, thus allowing greater accuracy in the interpretation of the exam.
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Stewart RB, Bardy GH, Greene HL. Wide complex tachycardia: misdiagnosis and outcome after emergent therapy. Ann Intern Med. 1986;104(6):766-71. https://doi.org/10.7326/0003-4819-104-6-766
Baxi RP, Hart KW, Vereckei A, Miller J, Chung S, Chang W, et al. Vereckei criteria used as a diagnostic tool by emergency medicine residents to distinguish between ventricular tachycardia and supra-ventricular tachycardia with aberrancy. J Cardiol. 2012;59(3):307-12. https://doi.org/10.1016/j.jjcc.2011.11.007
Isenhour JL, Craig S, Gibbs M, Littmann L, Rose G, Risch R. Wide-complex tachycardia: continued evaluation of diagnostic criteria. Acad Emerg Med. 2000;7(7):769-73. https://doi.org/10.1111/j.1553-2712.2000.tb02267.x.
Alzand BSN, Crijns HJGM. Diagnostic criteria of broad QRS complex tachycardia: decades of evolution. Europace. 2011;13(4):465-72.https://doi.org/10.1093/europace/euq430
Baerman JM, Morady F, DiCarlo LA Jr, de Buitleir M. Differentiation of ventricular tachycardia from supraventricular tachycardia with aberration: value of the clinical history. Ann Emerg Med. 1987;16(1):40-3. https://doi.org/10.1016/S0196-0644(87)80283-4
Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC): Developed in collaboration with the Association for European Paediatric and congenital Cardiology (AEPC). European Heart Journal. 2020;41(5):655-720. https://doi.org/10.1093/eurheartj/ehz467
Brugada P, Brugada J, Mont L, Smeets J, Andries EW. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991;83(5):1649-59. https://doi.org/10.1161/01.cir.83.5.1649
Bakker ALM, Nijkerk G, Groenemeijer BE, Waalewijn RA, Koomen EM, Braam RL, et al. The Lewis lead: making recognition of P waves easy during wide QRS complex tachycardia. Circulation. 2009;119(24):e592-3. https://doi.org/10.1161/CIRCULATIONAHA.109.852053
Moffa PJ, Sanchez PCR. Eletrocardiograma normal e patológico. São Paulo: Roca; 2001.
Marriott HJ. Differential diagnosis of supraventricular and ventricular tachycardia. Cardiology. 1990;77(3):209-20. https://doi.org/10.1159/000174602
Vereckei A, Duray G, Szénási G, Altemose GT, Miller JM. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm. 2008;5(1):89-98. https://doi.org/10.1016/j.hrthm.2007.09.020
Mann D, Zipes D, Libby P, Bonow R. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed, Saunders Elsevier, 2014.
Wellens HJ, Bär FW, Lie KI. The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. Am J Med 1978;64(1):27-33. https://doi.org/10.1016/002-9343(78)90176-6
Pava LF, Perafán P, Badiel M, Arango JJ, Mont L, Morillo CA, et al. R-wave peak time at DII: a new criterion for differentiating between wide complex QRS tachycardias. Heart Rhythm. 2010;7(7):922-6. https://doi.org/10.1016/j.hrthm.2010.03.001
Take Y, Morita H. Fragmented QRS: What Is The Meaning? Indian Pacing Electrophysiol J. 2012;12(5):213-25. https://doi.org/10.1016/s0972-6292(16)30544-7
Kindwall KE, Brown J, Josephson ME. Electrocardiographic criteria for ventricular tachycardia in wide complex left bundle branch block morphology tachycardias. Am J Cardiol. 1988;61(15):1279-83. https://doi.org/10.1016/0002-9149(88)91169-1
Santos JAB, Galvão Filho SS, Vasconcelos JTM, Pinna Junior BJB, Vitorino EMS, Martienzo ALA, et al. Diagnóstico de taquicardia ventricular do tipo fascicular através da cardioexploração eletrofisiológica transesofágica (Cete). Reblampa. 1998;11(1):31:9.
Lerman BB, Stein KM, Markovitz SM. Mechanism of idiopathic left ventricular tachycardia. J Cardiovasc Electrophysiol. 1997;8(5):571-83. https://doi.org/10.1111/j.1540-8167.1997.tb00826.x
Tchou P, Mehdirad AA. Bundle branch reentry ventricular tachycardia. Pacing Clin Electrophysiol. 1995;18(7):1427-37. https://doi.org/10.1111/j.1540-8159.1995.tb02605.x
Zipes DP, Jalife J. Cardiac Electrophysiology from Cell to Bedside. Philadelphia: Saunders/Elsevier; 2009. Atrioventricular reentry and variants.
Steurer G, Gürsoy S, Frey B, Simonis F, Andries E, Kuck K, et al. The differential diagnosis on the electrocardiogram between ventricular tachycardia and preexcited tachycardia. Clin Cardiol. 1994;17(6):306-8. https://doi.org/10.1002/clc.4960170606
