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Right bundle branch block-type wide QRS complex tachycardia with a reversed R/S complex in lead V(6): Development and validation of electrocardiographic differentiation criteria

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Author(s)
Minsu KimChang Hee KwonJi Hyun LeeKi Won HwangHyung Oh ChoiYong-Giun KimKwang-No LeeJinhee AhnHyoung-Seob ParkGi-Byoung Nam
Keimyung Author(s)
Park, Hyoung Seob
Department
Dept. of Internal Medicine (내과학)
Journal Title
Heart Rhythm
Issued Date
2020
Volume
18
Issue
2
Keyword
Differential diagnosisElectrocardiographyFascicular ventricular tachycardiaSupraventricular tachycardiaVentricular tachycardia
Abstract
Background:
Differentiation of supraventricular tachycardia (SVT) with a right bundle branch block (RBBB) pattern from ventricular tachycardia (VT) is difficult, particularly when the R/S ratio in lead V6 is below 1.0.

Objective:
We sought to investigate the electrocardiographic criteria for distinguishing between these arrhythmias.

Methods:
We investigated electrocardiographic parameters from 111 consecutive patients who had RBBB pattern wide QRS complex tachycardia with a reversed R/S ratio in lead V6 (72 VTs, 39 SVTs). Diagnostic criteria from the previous algorithms were compared with our new criterion, the RS/QRS ratio, which was defined as the ratio of the interval from the onset of the QRS complex to the nadir of the S wave, divided by the QRS width in lead V6. The RS/QRS ratio was further tested in a prospective population (31 fascicular VTs, 29 SVTs).

Results:
The diagnostic accuracy of previous criteria (Brugada algorithm, Vereckei algorithm, and R-wave peak time criterion) was only modest. However, the RS/QRS ratio in lead V6 was significantly lower in SVT than in VT (0.36 ± 0.04 vs 0.50 ± 0.08; P < .001). A cutoff value of the RS/QRS ratio >0.41 differentiated VT from SVT with a high diagnostic accuracy (sensitivity 97.2%; specificity 89.7%). When tested in a prospective population with fascicular VT, the diagnostic accuracy of the criteria was maintained (sensitivity 90.3%; specificity 86.2%).

Conclusion:
The RS/QRS ratio >0.41 in lead V6 is a simple and reliable index for distinguishing VT from SVT in RBBB pattern wide QRS complex tachycardia with a reversed R/S complex in lead V6. This criterion was particularly useful for the differential diagnosis of fascicular VT from RBBB pattern SVT.
Keimyung Author(s)(Kor)
박형섭
Publisher
School of Medicine (의과대학)
Citation
Minsu Kim et al. (2020). Right bundle branch block-type wide QRS complex tachycardia with a reversed R/S complex in lead V(6): Development and validation of electrocardiographic differentiation criteria. Heart Rhythm, 18(2), 181–188. doi: 10.1016/j.hrthm.2020.08.023
Type
Article
ISSN
1556-3871
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1547527120308663
DOI
10.1016/j.hrthm.2020.08.023
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43087
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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