Diagnosis Of Wide QRS Tachycardia Research Articles

A machine learning approach to differentiate wide QRS tachycardia: distinguishing ventricular tachycardia from supraventricular tachycardia.

Differential diagnosis of wide QRS tachycardia (WQCT) has been a challenging issue. Published algorithms to distinguish ventricular tachycardia (VT) and supraventricular tachycardia (SVT) have limited diagnostic capabilities. A total of 278 patients with WQCT from January 2010 to March 2022 were enrolled. The electrophysiological study confirmed SVT in 154 patients and VT in 65 ones. Two hundred nineteen WQCT 12-lead ECGs were randomly divided into development cohort (n = 165) and testing cohort (n = 54) data sets. The development cohort was split into a training group (n = 115) and an internal validation group (n = 50). Forty ECG features extracted from the 219 WQCT ECGs are fed into 9 iteratively trained ML algorithms. This novel ML algorithm was also compared with four published algorithms. In the development cohort, the Gradient Boosting Machine (GBM) model displayed the maximum area under curve (AUC) (0.91, 95% confidence interval (CI) 0.81-1.00). In the testing cohort, the GBM model had a higher AUC of 0.97 compared to 4 validated ECG algorithms, namely, Brugada (0.68), avR (0.62), RWPTII (0.72), and LLA algorithms (0.70). Accuracy, sensitivity, specificity, negative predictive value, and positive predictive value of the GBM model were 0.94, 0.97, 0.90, 0.94, and 0.95, respectively. A GBM ML model contributes to distinguishing SVT from VT based on surface ECG features. In addition, we were able to identify important indicators for distinguishing WQCT.

Differential diagnosis of wide QRS tachycardia: A review.

Differential diagnosis of wide QRS tachycardia (WQRST) on the electrocardiogram remains a challenging exercise. Correct diagnosis is important for prescribing appropriate therapy and determining prognosis. Differential diagnosis of wide QRS tachycardia revolves around differentiation between supraventricular tachycardia with aberrant conduction and ventricular tachycardia. Observations such as clinical history, findings of physical examination during tachycardia, AV dissociation, QRS morphology in lead V1 and lead V6, precordial concordance, RS complexes in precordial leads, contralateral bundle branch block during wide QRS tachycardia, R wave morphologies in lead aVR, and ventricular initial/terminal velocity of conduction ratio can help arrive at the correct diagnosis with reasonable accuracy. The observations described here can help arrive at the correct diagnosis of WQRST with both reasonable accuracy and confidence.

P1121A new EKG-based score with high positive predictive value for the differential diagnosis of wide QRS tachycardia

P1121A new EKG-based score with high positive predictive value for the differential diagnosis of wide QRS tachycardia

Polymorphic Ventricular Tachycardias with Involvement of the His-Purkinje System in Non-Ischemic Cardiomyopathy

Ventricular tachycardia (VT) associated with the His-Purkinje system has been infrequently reported in patients with structural heart disease. A 69-year-old man presented with nausea and diaphoresis. ECG showed wide QRS tachycardia with a right bundle branch block configuration as right axis deviation, 240 bpm. The tachycardia was temporarily terminated with verapamil but reinitiated and required several electrical cardioversions. Coronary angiography revealed no significant stenosis and left ventricular ejection fraction 34%. He underwent electrophysiological study to make a diagnosis of wide QRS tachycardia. When a ventricular tachycardia was induced, the presence of His deflections preceded every ventricular deflection and oscillations in the H-H cycle length resulted in variations in V-V cycle length. This suggested the possibility of the His-Purkinje entity. During the VT, the diastolic potential (DP) was recorded at the anteroseptal left ventricle. Changes in the QRS morphology were associated with the time between DP and onset of QRS complex (V), and prolongation of DP-V interval terminated the VT. Different exits from relatively large area of slow conduction around the left ventricular base area might have produced the polymorphic VTs. In addition, the delayed potentials were seen during sinus rhythm around this area. We report this case of a patient who had non-ischemic cardiomyopathy and developed Purkinje reentrant polymorphic VT.

An Interesting Case in Differential Diagnosis of wide-QRS Tachycardia —AV Reciprocating Tachycardia with Enhanced AV Nodal Conduction—

An Interesting Case in Differential Diagnosis of wide-QRS Tachycardia —AV Reciprocating Tachycardia with Enhanced AV Nodal Conduction—

Lewis Lead Enhances Atrial Activity Detection in Wide QRS Tachycardia

Background: The differential diagnosis of wide QRS tachycardia is a challenge for the emergency physician. The major tool is the electrocardiogram (ECG), even though the sensitivity and specificity may be variable, depending on presentation. Additional leads could be used to improve the diagnostic accuracy of the ECG. Objective: To document the use of the Lewis lead in improving the diagnostic accuracy of the ECG in wide QRS tachycardia. Case report: A 52-year-old woman with rheumatoid arthritis, in treatment with methotrexate, was admitted with progressive dyspnea that evolved to acute respiratory distress and shock at arrival. Pneumonia was diagnosed as the infection and she received antibiotics, and respiratory and inotropic support. She was also using amiodarone for more than 10 years, but she couldn't state the reason. On cardiac monitoring, wide QRS tachycardia was detected and ventricular tachycardia was considered on the differential diagnosis. The standard 12-lead ECG was complemented with the Lewis lead, obtained with higher speed and amplitude, demonstrating atrioventricular concordance and excluding ventricular tachycardia. The patient was treated for septic shock, and she died 2 days later. Conclusion: The Lewis lead is a simple and easy strategy to enhance atrial activity detection in wide QRS tachycardia.

Adenosine for diagnosis of wide QRS tachycardia: Rapid infusion for an easier conclusion*

Rush University Medical Center; Chicago, IL The author has not disclosed any potential conflicts of interest.

Differential Diagnosis of Wide QRS Tachycardia by Electrocardiogram

Background and Objectives：The differential diagnosis of a regular tachycardia, with a wide QRS complex (≥120 msec) on the 12-lead electrocardiogram (ECG), remains an important challenge. Despite the information available on electrocardiography in patients with ventricular tachycardia (VT) and supraventricular ventricular tachycardia, with aberrant conduction or pre-existed bundle branch block (wide-QRS SVT)；the data from Korean is limited. The purpose of this study was to report on the differential diagnostic criteria. Subjects and Methods：The clinical and electrocardiographic characteristics of 150 patients (65.8%) with VT, and 78 (34.2%) with wide-QRS SVT, were evaluated. Results：An atrioventricular (AV ) dissociation was found in 44.7% (67/150) of the VTs, which is very useful in differential diagnosis. In the RBBB patterns, a monophasic R, or a biphasic, wave (QR, RS), in the V1 lead, were present in 49.0 and 40.6% of VTs, respectively, and an R/S ratio of less than 1, in the V6 lead, was present in 89.6% of VTs. In the LBBB patterns, the duration of the R wave (≥30 msec), the interval from the Q wave to the nadir of the S wave (≥70 msec) and the notching of the S wave, in the V1 lead, were present in 61.1, 87.0 and 31.3% of VTs, respectively. When an algorithm, using the AV dissociation and morphological criteria for a VT in the V1 and V6 leads, was tested for differentiation, the sensitivity and specificity were 96.7 and 93.6%, respectively. Conclusion：A more accurate, correct, diagnosis of wide-QRS tachycardia can be made by using a stepwise approaching method consisting of AV dissociation and morphological criteria for VT in the V1

Effect of adenosine or adenosine triphosphate on antidromic tachycardia

Objectives. This study was designed to determine the effect of adenosine or adenosine triphosphate (ATP) on antidromic tachycardia.Background. Adenosine and adenosine triphosphate are useful for differential diagnosis of wide QRS tachycardia. It has been believed that tachycardia termination caused by these agents is due to the preferential depressive effect on the atrioventricular (AV) node, whereas their effect on accessory pathways is minimal. Methods. We studied the effect of adenosine or ATP on the termination pattern of antidromic tachycardia in 17 patients (10 men, 7 women; mean age [±SD] 32 ± 11 years) with one or more accessory pathways. Adenosine (6 to 12 mg [n = 10]) or ATP (8 to 20 mg [n = 7]) was injected rapidly through a central venous line and followed by 10 ml of saline flush after induction of sustained antidromic tachycardia.Results. Tachycardia was terminated in < 2 min in 14 patients (82%) after the injection and remained unchanged in 3 (18%). Tachycardia termination was due to conduction block in the accessory pathway (anterograde limb) in seven patients (50%) and in the AV node (retrograde limb) in another seven. Adenosine or ATP caused accessory pathway block in seven (88%) of the eight patients lacking retrograde accessory pathway conduction and in none of the nine patients having retrograde accessory pathway conduction (p < 0.01). All five ptients with an atriofascicular accessory pathway and unidirectional anterograde conduction had tachycardia termination due to anterograde accessory pathway block after injection of adenosine or ATP.Conclusions. 1) Adenosine or ATP effectively terminates antidromic tachycardia; 2) the termination is related to block in either the accessory pathway or the AV node; 3) accessory pathway block occurs in patients with a unidirectional, anterogradely conducting accessory pathway, especially an atriofascicular accessory pathway.

Differential Diagnosis of Wide QRS Tachycardia by Electrocardiogram

Differential Diagnosis of Wide QRS Tachycardia by Electrocardiogram