Simplified Integrated Clinical and Electrocardiographic Algorithm for Differentiation of Wide QRS Complex Tachycardia: The Basel Algorithm

Abstract

Background: Prompt differential diagnosis of wide QRS complex tachycardia (WCT) is crucial to patient management. However, distinguishing ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with wide QRS complexes remains problematic, especially for nonelectrophysiologists.

Objectives: This study aimed to develop a simple-to-use algorithm with integration of clinical and electrocardiographic (ECG) parameters for the differential diagnosis of WCT.

Methods: The 12-lead ECGs of 206 monomorphic WCTs (153 VT, 53 SVT) with electrophysiology-confirmed diagnoses were analyzed. In the novel Basel algorithm, VT was diagnosed in the presence of at least 2 of the following criteria: 1) clinical high risk features; 2) lead II time to first peak >40 ms; and 3) lead aVR time to first peak >40 ms. The algorithm was externally validated in 203 consecutive WCT cases (151 VT, 52 SVT). Its' diagnostic performance and clinical applicability were compared with those of the Brugada and Vereckei algorithms.

Results: The Basel algorithm showed a sensitivity, specificity, and accuracy of 92%, 89%, and 91%, respectively, in the derivation cohort and 93%, 90%, and 93%, respectively, in the validation cohort. There were no significant differences in the performance characteristics between the 3 algorithms. The evaluation of the clinical applicability of the Basel algorithm showed similar diagnostic accuracy compared with the Brugada algorithm (80% vs 81%; P = 1.00), but superiority compared with the Vereckei algorithm (72%; P = 0.03). The Basel algorithm, however, enabled a faster diagnosis (median 36 seconds vs 105 seconds for the Brugada algorithm [P = 0.002] and 50 seconds for the Vereckei algorithm [P = 0.02]).

Conclusions: The novel Basel algorithm based on simple clinical and ECG criteria allows for a rapid and accurate differential diagnosis of WCT.

Keywords: ECG; algorithm; cardiac arrhythmia; sudden cardiac death; supraventricular tachycardia; ventricular tachycardia; wide QRS complex tachycardia.