A scoring algorithm in wide complex tachycardia: Ventricular tachycardia or not ventricular tachycardia?

Wide complex tachycardia (WCT) is a heart rhythm that occurs at a rate >100 beats per minute with an electrocardiogram (ECG) QRS duration of ≥120 ms. The most common cause of WCT is ventricular tachycardia (VT), followed by supraventricular tachycardia (SVT) with abnormal intraventricular conduction. This type of SVT can be SVT with aberrant conduction (preexistent bundle branch block or functional bundle branch block), pre-excited SVT (antidromic atrioventricular reentry tachycardia [accessory pathway participating in reentry circuit], or atrial tachycardia/atrial flutter/atrioventricular nodal reentry tachycardia with bystander accessory pathway), SVTwith intramyocardial conduction delay (cardiomyopathy), or SVT with wide QRS due to drug toxicity or electrolyte disturbance.1 Other causes ofWCT are ventricular paced rhythm and artifact. Differentiating between VT andSVTwith abnormal conduction is important for acutemanagement of arrhythmia, but is also important to help determine further therapeutic measures and prognosis. Several algorithms have been created to helpmake this differentiation. In 1991, Brugada et al proposed four new criteria that were incorporated in a stepwise approach to differentiate between VT and SVT with abnormal conduction. The sensitivity of these four consecutive steps was 0.987 and the specificity was 0.965.2 The Brugada criteria are shown in Figure 1. Vereckei et al devised a new algorithm in 2007

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