Evaluation of the specificity of morphological electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardia in patients with intraventricular conduction defects
| Autor: | Aureliano Almazán, Jesús Almendral, Jose Luis Cantalapiedra, Teresa Alberca, Petra Sanz, Juan L. Delcán |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Tachycardia
Adult Male medicine.medical_specialty Heart block Bundle-Branch Block Context (language use) Sensitivity and Specificity Diagnosis Differential QRS complex Electrocardiography Heart Rate Reference Values Physiology (medical) Internal medicine Ventricular Dysfunction Medicine Humans Sinus rhythm Prospective Studies Aged Aged 80 and over Bundle branch block medicine.diagnostic_test business.industry Arrhythmias Cardiac Middle Aged medicine.disease Evaluation Studies as Topic Cardiology Tachycardia Ventricular Female medicine.symptom Differential diagnosis Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 96(10) |
| ISSN: | 0009-7322 |
| Popis: | 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 ≥0.90 among our patients: (1) a triphasic configuration (Rsr′or Rr′) QRS complex in V 1 in the presence of a right bundle-branch block morphology (BBBM); (2) a QS, QR, or R QRS pattern in V 6 in the presence of a right BBBM; (3) any Q in V 6 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 V 1 with right BBBM, and a relation R/S 30 ms in lead V 1 or V 2 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. |
| Databáze: | OpenAIRE |
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