Document Detail

Evaluation of the specificity of morphological electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardia in patients with intraventricular conduction defects.
MedLine Citation:
PMID:  9396451     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although several ECG criteria have been described for the differential diagnosis of tachycardias with a wide QRS complex, their applicability in patients with preexisting intraventricular conduction defects (IVCDs) has been questioned. The specificity of previously described criteria in this context is unknown. METHODS AND RESULTS: We analyzed prospectively the specificity of the QRS morphological criteria previously described in ECGs during sinus rhythm of 232 patients with IVCD. Only 5 of 12 analyzed criteria had a specificity > or = 0.90 among our patients: (1) a triphasic configuration (Rsr' or Rr') QRS complex in V1 in the presence of a right bundle-branch block morphology (BBBM); (2) a QS, QR, or R QRS pattern in V6 in the presence of a right BBBM; (3) any Q in V6 in the presence of a left BBBM; (4) a concordant pattern in all precordial leads; and (5) the absence of an RS complex in all precordial leads (particularly useful for left BBBM). The following criteria--QRS duration > 140 ms; a left axis with right BBBM, right superior axis with right BBBM, monophasic or biphasic R wave in V1 with right BBBM, and a relation R/S < 1 with right BBBM; an R > 30 ms in lead V1 or V2 with left BBBM, > 60 ms from QRS onset to S nadir with left BBBM, a notched downstroke S wave with left BBBM, and an R-to-S interval > 100 ms in one precordial lead--had a specificity of 0.43, 0.54, 0.87, 0.80, 0.85, 0.78, 0.66, 0.69, and 0.63 (0.84 in right BBBM), respectively. CONCLUSIONS: Most of the previously described morphological criteria favoring ventricular tachycardia are present in a substantial percentage of patients with IVCD during sinus rhythm. These findings suggest a limited applicability of these criteria in this subset of patients.
T Alberca; J Almendral; P Sanz; A Almazan; J L Cantalapiedra; J L Delcán
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  96     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1997 Nov 
Date Detail:
Created Date:  1998-01-09     Completed Date:  1998-01-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  3527-33     Citation Subset:  AIM; IM    
Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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MeSH Terms
Aged, 80 and over
Arrhythmias, Cardiac / diagnosis*,  physiopathology
Bundle-Branch Block / diagnosis,  physiopathology
Diagnosis, Differential
Electrocardiography / methods*
Evaluation Studies as Topic
Heart Rate / physiology
Middle Aged
Prospective Studies
Reference Values
Sensitivity and Specificity
Tachycardia, Ventricular / diagnosis*,  physiopathology
Ventricular Dysfunction / physiopathology*

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