Diagnostic Value of the Brugada Algorithm in Differential Diagnosis of Wide QRS Tachycardia by Electrocardiogram

Choi, Wook Jin; Kim, Won; Kang, Hui Dong; Sohn, Yoo Dong; Lee, Jae Ho; Oh, Bum Jin; Lim, Kyoung Soo

Abstract

PURPOSE
In dealing with wide-complex tachycardia (WCT), it is important to distinguish between ventricular tachycardia (VT), supraventricular tachycardia with aberrancy (SVTAC), and preexcited tachycardia by using an accessory pathway. The aim of this study was to investigate and compare the Brugada and the Bayesian algorithms and to analyze the parameters.
METHODS
Between January 1999 and December 2003, the Brugada and the Bayesian approaches were retrospectively analyzed in 103 WCTs confirmed by electrophysiologic studies.
RESULTS
Seven-eight (75) VTs and 25 SVTs were found. The sensitivity and the specificity for VT achieved by using the Brugada approach were 91.0 and 68.0%, respectively, whereas those achieved by using the Bayesian approach were 84.6 and 60.0%. In the Brugada approach, the most important step was the fourth step (odds ratio: 4.33; 95% CI: 1.75-12.14). In the Bayesian approach, triphasic rsR' or rR' morphology (odds ratio: 3.93; 95% CI: 1.46-10.56), r > or = 0.04 s or notched S downstroke or delayed S nadir > 0.06 s in the V1 or the V2 lead (odds ratio: 5.75; 95% CI: 1.26?26.28), and intrinsicoid deflection > or = 0.08 s in the V6 lead (odds ratio: 6.88; 95% CI: 1.33-27.79) were more important parameters. Seven (7) VTs of 103 tachycardias were mis-classified when the Brugada approach was used. Applying additional criteria (QRS width > 0.16 s and intrinsicoid deflection > or = 0.08 s in V6 lead), three of those VTs were diagnosed correctly.
CONCLUSIONS
The Brugada algorithm achieved a lower sensitivity and specificity than those reported by Brugada et al. If both the V1 and the V6 leads do not fulfill the criteria for VT, additional parameters should be evaluated.