Email this article New ECG criteria for differential diagnosis of wide QRS complex tachycardias with right bundle branch block pattern
- Authors: Shlevkov NB1, Salami HF1, Kiktev VG1, Sokolov SF1
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Affiliations:
- A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology of the Ministry of Health of Russian Federation
- Issue: Vol 91, No 4 (2019)
- Pages: 83-89
- Section: Editorial
- URL: https://journals.rcsi.science/0040-3660/article/view/33620
- DOI: https://doi.org/10.26442/00403660.2019.04.000210
- ID: 33620
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Abstract
Aim. To evaluate standard 12-lead ECG indices for the differential diagnosis of wide QRS tachycardias with right bundle branch block (RBBB) pattern. Materials and methods. Study analyses the 244 ECG indices in 111 patients (79 males and 32 females, age 53±17 years) with RBBB tachycardias, who underwent electrophysiological studies. First step includes retrospective analysis of QRS characteristics in 20 patients with ventricular tachycardias (VT), 24 pts with aberrant supraventricular tachycardias (SVT+RBBB) and 14 pts with antidromic SVTs (WPW). ROC- and multifactorial analyses were performed to develop diagnostic ECG algorithms. The prognostic accuracy of the algorithms was subsequently evaluated on a prospective group of patients with RBBB tachycardias (n=53). Results and discussion. ECG criteria of RBBB VTs were: 1) the presence Q-wave in lead II, 2) the duration interval R(peak)-S(end) >100 ms in lead V5. ECG criteria for antidromic SVTs with RBBB were: 1) the duration of the R wave in lead I ≥80 ms, 2) the absence of split (M-sharp) R-waves in lead V2, 3) the absence notch in ascending S wave in lead aVL. The accuracy of the algorhythm for diagnostic of VTs with RBBB was 83% (sensitivity 100%, specificity 73%). The accuracy of the algorhythm for diagnostic of antidromic SVTs with RBBB was 91% (sensitivity 85%, specificity 96%). Conclusion. The proposed algorithms are based on new ECG criteria for the differential diagnosis of wide QRS complexes tachycardias with RBBB pattern, unlike the previous algorithms.
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##article.viewOnOriginalSite##About the authors
N B Shlevkov
A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology of the Ministry of Health of Russian Federation
Email: nik.shlevkov@inbox.ru
к.м.н., с.н.с. лаб. интервенционных методов диагностики и лечения нарушений ритма, проводимости сердца и синкопальных состояний отд. клинической электрофизиологии и рентгенхирургических методов лечения нарушений ритма сердца Moscow, Russia
H F Salami
A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology of the Ministry of Health of Russian Federationаспирант отд. клинической электрофизиологии и рентгенхирургических методов лечения нарушений ритма и проводимости сердца Moscow, Russia
V G Kiktev
A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology of the Ministry of Health of Russian Federationк.м.н., с.н.с. лаб. интервенционных методов диагностики и лечения нарушений ритма, проводимости сердца и синкопальных состояний отд. клинической электрофизиологии и рентгенхирургических методов лечения нарушений ритма сердца Moscow, Russia
S F Sokolov
A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology of the Ministry of Health of Russian Federationк.м.н, в.н.с. лаб. интервенционных методов диагностики и лечения нарушений ритма, проводимости сердца и синкопальных состояний отд. клинической электрофизиологии и рентгенхирургических методов лечения нарушений ритма сердца Moscow, Russia
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