Simple electrocardiographic criteria for rapid identification of wide QRS complex tachycardia: The new limb lead algorithm

Qiong Chen, Jinyi Xu, Carola Gianni, Chintan Trivedi, Domenico G. Della Rocca, Mohamed Bassiouny, Ugur Canpolat, Alfredo Chauca Tapia, J. David Burkhardt, Javier E. Sanchez, Patrick Hranitzky, G. Joseph Gallinghouse, Amin Al-Ahmad, Rodney Horton, Luigi Di Biase, Sanghamitra Mohanty, Andrea Natale

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Tachycardia
Extremities
Ventricular Tachycardia
Electrocardiography
Lead
Supraventricular Tachycardia
Electrophysiology
Differential Diagnosis

Keywords

  • Algorithm
  • Electrocardiography
  • Opposing QRS in the limb leads
  • Ventricular tachycardia
  • Wide QRS complex tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Chen, Q., Xu, J., Gianni, C., Trivedi, C., Della Rocca, D. G., Bassiouny, M., ... Natale, A. (Accepted/In press). Simple electrocardiographic criteria for rapid identification of wide QRS complex tachycardia: The new limb lead algorithm. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2019.09.021

Simple electrocardiographic criteria for rapid identification of wide QRS complex tachycardia : The new limb lead algorithm. / Chen, Qiong; Xu, Jinyi; Gianni, Carola; Trivedi, Chintan; Della Rocca, Domenico G.; Bassiouny, Mohamed; Canpolat, Ugur; Tapia, Alfredo Chauca; Burkhardt, J. David; Sanchez, Javier E.; Hranitzky, Patrick; Gallinghouse, G. Joseph; Al-Ahmad, Amin; Horton, Rodney; Di Biase, Luigi; Mohanty, Sanghamitra; Natale, Andrea.

In: Heart Rhythm, 01.01.2019.

Research output: Contribution to journalArticle

Chen, Q, Xu, J, Gianni, C, Trivedi, C, Della Rocca, DG, Bassiouny, M, Canpolat, U, Tapia, AC, Burkhardt, JD, Sanchez, JE, Hranitzky, P, Gallinghouse, GJ, Al-Ahmad, A, Horton, R, Di Biase, L, Mohanty, S & Natale, A 2019, 'Simple electrocardiographic criteria for rapid identification of wide QRS complex tachycardia: The new limb lead algorithm', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2019.09.021
Chen, Qiong ; Xu, Jinyi ; Gianni, Carola ; Trivedi, Chintan ; Della Rocca, Domenico G. ; Bassiouny, Mohamed ; Canpolat, Ugur ; Tapia, Alfredo Chauca ; Burkhardt, J. David ; Sanchez, Javier E. ; Hranitzky, Patrick ; Gallinghouse, G. Joseph ; Al-Ahmad, Amin ; Horton, Rodney ; Di Biase, Luigi ; Mohanty, Sanghamitra ; Natale, Andrea. / Simple electrocardiographic criteria for rapid identification of wide QRS complex tachycardia : The new limb lead algorithm. In: Heart Rhythm. 2019.
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abstract = "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.",
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T2 - The new limb lead algorithm

AU - Chen, Qiong

AU - Xu, Jinyi

AU - Gianni, Carola

AU - Trivedi, Chintan

AU - Della Rocca, Domenico G.

AU - Bassiouny, Mohamed

AU - Canpolat, Ugur

AU - Tapia, Alfredo Chauca

AU - Burkhardt, J. David

AU - Sanchez, Javier E.

AU - Hranitzky, Patrick

AU - Gallinghouse, G. Joseph

AU - Al-Ahmad, Amin

AU - Horton, Rodney

AU - Di Biase, Luigi

AU - Mohanty, Sanghamitra

AU - Natale, Andrea

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Algorithm

KW - Electrocardiography

KW - Opposing QRS in the limb leads

KW - Ventricular tachycardia

KW - Wide QRS complex tachycardia

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