Novel criterion for the differential diagnosis of wide QRS complexes and wide complex tachycardia using the initial activation of QRS on leads V1 and V2

摘要

BackgroundMany diagnostic criteria for the differential diagnosis of wide complex tachycardia (WCT) are complex and not completely accurate. Incorrect diagnosis is also related to error in applying criteria. ObjectivesTo propose a novel reliable criterion for wide QRS complexes' differential diagnosis. Material and methodsOne hundred Electrocardiograms (ECGs) with wide QRS complexes were analyzed using the ECG software. Five variables were measured during the first 20?ms of QRS in leads V1 and V2 and compared between premature ventricular contraction (PVC) and conducted supraventricular impulse with bundle branch block (BBB) groups. The best discriminant variable was identified. The validity of this variable was tested on a group of 20 patients who had WCT during an electrophysiology study. ResultsAlmost all variables were statistically different between PVC and BBB groups. The sum of voltages in absolute value of vectors during the initial 20?ms of the QRS in leads V1 and V2 (ΣV1?+?V2) was the most discriminant between the two groups (131?±?85 microvolt [μV] vs. 498?±?392?μV, p?