Background
The electrocardiogram (ECG) is essential for the differential diagnosis of wide QRS
complex tachycardia (WCT).
Objective
The purpose of this study was to evaluate the diagnostic value of a novel ECG algorithm
on the basis of the morphological characteristics of the QRS on the limb leads.
Methods
The limb lead algorithm (LLA) was evaluated by analyzing 528 monomorphic WCTs with
electrophysiology-confirmed diagnoses. In the LLA, ventricular tachycardia (VT) is
diagnosed in the presence of at least 1 of the following: (1) monophasic R wave in
lead aVR; (2) predominantly negative QRS in leads I, II, and III; and (3) opposing
QRS complex in the limb leads: concordant monophasic QRS in all 3 inferior leads and concordant monophasic QRS in 2 or 3 of the remaining limb leads with a polarity opposite
to that of the inferior leads. The diagnostic performance of the LLA was compared
with that of the Brugada, Vereckei, and R-wave peak time (RWPT) algorithms.
Results
Of 528 WCT cases, 397 were VT and 131 supraventricular tachycardia. The interobserver
agreement for the LLA was excellent (κ = 0.98), better than that for the other algorithms.
The overall accuracy of the LLA (88.1%) was similar to that of Brugada (85.4%) and
Vereckei (88.1%) algorithms but was higher than that of the RWPT algorithm (70.8%).
The LLA had a lower sensitivity (87.2%) than did Brugada (94.0%) and Vereckei (92.4%)
algorithms, but not the RWPT algorithm (67.8%). Furthermore, the LLA showed a higher
specificity (90.8%) than did Brugada (59.5%), Vereckei (76.3%), and RWPT (80.2%) algorithms.
Conclusion
The LLA is a simple yet accurate method to diagnose VT when approaching WCTs on the
ECG.
Keywords
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Article info
Publication history
Published online: September 20, 2019
Footnotes
Dr Natale received honoraria from Boston Scientific, Biosense Webster, Janssen, St. Jude Medical, Biotronik, and Medtronic. The rest of the authors report no conflicts of interest.
Identification
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