Diagnostic criteria of broad QRS complex tachycardia: decades of evolution.

Broad QRS complex tachycardia still presents a diagnostic challenge when confronted with a 12-lead electrocardiogram (ECG). The ECG differential diagnosis includes ventricular tachycardia vs. supraventricular tachycardia with functional aberration, pre-existing bundle branch block, intraventricular conduction disturbances, or pre-excitation. Despite all available criteria, broad complex tachycardias are still misdiagnosed or remain undiagnosed. This paper will briefly review the most recognized criteria.

[1]  I. Sandler,et al.  The Differential Morphology of Anomalous Ventricular Complexes of RBBB‐Type in Lead V1: Ventricular Ectopy versus Aberration , 1965, Circulation.

[2]  H. Marriott,et al.  Criteria, old and new, for differentiating between ectopic ventricular beats and aberrant ventricular conduction in the presence of atrial fibrillation , 1966 .

[3]  A. Kistin,et al.  Reevaluation of Electrocardiographic and Bedside Criteria for Diagnosis of Ventricular Tachycardia , 1967, Circulation.

[4]  Differential diagnosis of supraventricular and ventricular tachycardia. , 1970, Geriatrics.

[5]  H. Marriott,et al.  Morphologic features of right ventricular ectopic beats. , 1972, The American journal of cardiology.

[6]  E. Nikkila.  Letter: Serum high-density-lipoprotein and coronary heart-disease. , 1976, Lancet.

[7]  H. Wellens,et al.  The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. , 1978, The American journal of medicine.

[8]  Jerónimo Farré,et al.  The Differentiation between Ventricular Tachycardia and Supraventricular Tachycardia with Aberrant Conduction: The Value of the 12-Lead Electrocardiogram , 1981 .

[9]  P. Coumel,et al.  The QRS morphology in post-myocardial infarction ventricular tachycardia. A study of 100 tracings compared with 70 cases of idiopathic ventricular tachycardia. , 1984, European heart journal.

[10]  A. Camm,et al.  MISDIAGNOSIS OF CHRONIC RECURRENT VENTRICULAR TACHYCARDIA , 1985, The Lancet.

[11]  F. Morady,et al.  A prevalent misconception regarding wide-complex tachycardias. , 1985, JAMA.

[12]  H. Greene,et al.  Wide complex tachycardia: misdiagnosis and outcome after emergent therapy. , 1987, Annals of internal medicine.

[13]  M. Josephson,et al.  Hazards of intravenous verapamil for sustained ventricular tachycardia. , 1987, The American journal of cardiology.

[14]  P. Brugada,et al.  Diagnosis of ventricular tachycardia from the 12-lead electrocardiogram. , 1987, Cardiology clinics.

[15]  F. Morady,et al.  Differentiation of ventricular tachycardia from supraventricular tachycardia with aberration: value of the clinical history. , 1987, Annals of emergency medicine.

[16]  M. Josephson,et al.  Electrocardiographic criteria for ventricular tachycardia in wide complex left bundle branch block morphology tachycardias. , 1988, The American journal of cardiology.

[17]  H. Crijns,et al.  Supraventricular tachycardia mimicking ventricular tachycardia during flecainide treatment. , 1988, The American journal of cardiology.

[18]  P. Tchou,et al.  Useful clinical criteria for the diagnosis of ventricular tachycardia. , 1988, The American journal of medicine.

[19]  W. Black,et al.  Effect of preexisting bundle branch block on the electrocardiographic diagnosis of ventricular tachycardia. , 1988, The American journal of cardiology.

[20]  M Akhtar,et al.  Sustained bundle branch reentry as a mechanism of clinical tachycardia. , 1989, Circulation.

[21]  Roger Smith.  Wide QRS complex tachycardia: Reappraisal of a common clinical problem , 1989 .

[22]  T. J. Killian,et al.  Adenosine Increases Sympathetic Nerve Traffic in Humans , 1991, Circulation.

[23]  A. Camm,et al.  Multivariate analysis to simplify the differential diagnosis of broad complex tachycardia. , 1991, British heart journal.

[24]  Josep Brugada,et al.  A New Approach to the Differential Diagnosis of a Regular Tachycardia With a Wide QRS Complex , 1991, Circulation.

[25]  J. Langberg,et al.  Radiofrequency catheter ablation for treatment of bundle branch reentrant ventricular tachycardia: results and long-term follow-up. , 1991, Journal of the American College of Cardiology.

[26]  A. Camm,et al.  Difficulties in the use of electrocardiographic criteria for the differential diagnosis of left bundle branch block pattern tachycardia in patients with a structurally normal heart. , 1992, European heart journal.

[27]  J. Brugada,et al.  The Hemodynamic Mechanism of Pounding in the Neck in Atrioventricular Nodal Reentrant Tachycardia , 1992 .

[28]  J. Kingma,et al.  Comparison in the Same Patient of Aberrant Conduction and Bundle Branch Reentry After Dofetilide, a New Selective Class III Antiarrhythmic Agent , 1993, Pacing and clinical electrophysiology : PACE.

[29]  S. Deshpande,et al.  Bundle Branch Reentrant Ventricular Tachycardia: , 1993, Journal of cardiovascular electrophysiology.

[30]  Changes of intracardiac conduction induced by antiarrhythmic drugs. Importance of use- and reverse use-dependence , 1993 .

[31]  J. Kingma,et al.  Sequential Bilateral Bundle Branch Block During Dofetilide, A New Class III Antiarrhythmic Agent, In a Patient with Atrial Fibrillation , 1993, Journal of cardiovascular electrophysiology.

[32]  A. Camm,et al.  Ventricular tachycardia as default diagnosis in broad complex tachycardia , 1994, The Lancet.

[33]  P. Brugada,et al.  The differential diagnosis on the electrocardiogram between ventricular tachycardia and preexcited tachycardia , 1994, Clinical cardiology.

[34]  P. Tchou,et al.  Long‐Term Clinical Outcome of Right Bundle Branch Radiofrequency Catheter Ablation for Treatment of Bundle Branch Reentrant Ventricular Tachycardia , 1995, Pacing and clinical electrophysiology : PACE.

[35]  H. Wellens,et al.  Cure of Interfascicular Reentrant Ventricular Tachycardia by Ablation of the Anterior Fascicle of the Left Bundle Branch , 1995, Journal of cardiovascular electrophysiology.

[36]  W. Grimm,et al.  [Value of old and new electrocardiography criteria for differential diagnosis between ventricular tachycardia and supraventricular tachycardia with bundle branch block]. , 1996, Zeitschrift fur Kardiologie.

[37]  R. Frank,et al.  Diagnostic Clues From the Surfaee ECG to Identify Idiopathic (Fascicular) Ventricular Tachycardia: Correlation with Electrophysiologic Findings , 1996, Journal of cardiovascular electrophysiology.

[38]  A. Almazán,et al.  Evaluation of the specificity of morphological electrocardiographic criteria for the differential diagnosis of wide QRS complex tachycardia in patients with intraventricular conduction defects. , 1997, Circulation.

[39]  Gregory F. Michaud,et al.  Physician interpretation of electrocardiographic artifact that mimics ventricular tachycardia. , 2001, The American journal of medicine.

[40]  H. Wellens,et al.  Ventricular tachycardia: diagnosis of broad QRS complex tachycardia , 2001 .

[41]  S. Kutalek,et al.  Proarrhythmic effects of adenosine: one decade of clinical data. , 2002, American journal of therapeutics.

[42]  H. Wellens,et al.  Wide QRS Complex Tachycardia with Negative Precordial Concordance: Always a Ventricular Origin? , 2003, Journal of cardiovascular electrophysiology.

[43]  Subcommittees.  2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2005 .

[44]  I. Kakadiaris,et al.  Images in cardiovascular medicine. Detection of luminal-intimal border and coronary wall enhancement in intravascular ultrasound imaging after injection of microbubbles and simultaneous sonication with transthoracic echocardiography. , 2005, Circulation.

[45]  Aha.  2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care , 2005 .

[46]  John M. Miller,et al.  Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia. , 2006, European heart journal.

[47]  John M. Miller,et al.  New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. , 2008, Heart rhythm.

[48]  H. Wellens,et al.  The Lewis lead: making recognition of P waves easy during wide QRS complex tachycardia. , 2009, Circulation.

[49]  H. Wellens,et al.  An “Almost Wide” QRS Tachycardia , 2009, Circulation. Arrhythmia and electrophysiology.

[50]  A. van Oosterom,et al.  Development of a toolbox for electrocardiogram-based interpretation of atrial fibrillation. , 2009, Journal of electrocardiology.

[51]  Li Xuebing.  New algorithm using only lead AVR for differential diagnosis of wide QRS complex tachycardia , 2009 .