Key result
The slow conduction index demonstrated high diagnostic accuracy for differentiating wide QRS complex arrhythmias with LBBB morphology across multiple ECG leads, with the highest accuracy in lead aVL (AUC 0.94).
Why the study?
Differential diagnosis of wide QRS arrhythmias is challenging, and the slow conduction index algorithm is limited by requiring an RS complex and randomly selecting an ECG lead, potentially yielding contradictory results.
Does the slow conduction index accurately differentiate wide QRS complex arrhythmias with LBBB morphology across all 12 ECG leads in patients with premature wide QRS complexes?
Cross-Sectional (n=28)
No
Does the slow conduction index accurately differentiate wide QRS complex arrhythmias with LBBB morphology across all 12 ECG leads in patients with premature wide QRS complexes?
Effect estimate: AUC 0.94 (95% CI 0.90-0.96)
p-value: p=<0.001
The slow conduction index can be effectively used in multiple standard ECG leads (especially aVL, V2, aVF, V5, and III) to differentiate wide QRS complex arrhythmias with LBBB morphology, removing the need to search specifically for an RS-type complex.
May improve ECG differentiation of wide QRS arrhythmias; leaves open prospective validation before clinical adoption.
Differential diagnosis of wide QRS complex arrhythmias is one of the most challenging tasks in routine practice arrhythmology. The analysis of the wide QRS complex morphology has been introduced due to the complex problem of detecting atrial waves on ECG. A slow conduction index based on the ratio of the initial and terminal QRS amplitudes is one of the solutions to evaluate conduction velocity based on the surface ECG due to a significant variability of QRS morphology and real complexity of its detailed assessment. However, one of the significant limitations of this algorithm is a need to search for the RS wide complex type and randomly select an ECG lead with this morphology which can finally create a contradictory result. AIM: To evaluate a possibility of using the slow conduction index for differential diagnosis of wide QRS complex arrhythmias with left bundle branch (LBBB) morphology in any of 12-leads ECG followed by evaluation of the obtained diagnostic accuracy values. MATERIALS AND METHODS: The study included 280 single premature wide QRS complexes with LBBB morphology recorded during holter ECG monitoring in randomly selected 28 patients. Atrial extrasystoles were recorded in 14 patients and ventricular extrasystoles were captured during sinus rhythm in other 14 patients. A ROC analysis was used for the qualitative and quantitative assessment of a slow conduction index diagnostic values based on sensitivity (Sn), specificity (Sp) and accuracy (Acc). RESULTS: The highest values of Sn and Sp were obtained for a slow conduction index in the leads aVL, V2, aVF, V5 and III, and the lowest for the leads I, V3 and V6 based on the calculated area (AUC) under the ROC curves (p 0.001 for all leads). CONCLUSION: The study presented the fundamental possibility of using a slow conduction index in any of 12-lead ECG for the differential diagnosis of wide QRS complex arrhythmias with LBBB morphology.
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Chmelevsky et al. (2022) conducted a cross-sectional in Wide QRS complex arrhythmias with left bundle branch block (LBBB) morphology (n=28). Slow conduction index was evaluated on Diagnostic accuracy (Area Under the Curve) of the slow conduction index in lead aVL (AUC 0.94, 95% CI 0.90-0.96, p=<0.001). The slow conduction index demonstrated high diagnostic accuracy for differentiating wide QRS complex arrhythmias with LBBB morphology across multiple ECG leads, with the highest accuracy in lead aVL (AUC 0.94).
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