Key result
Inferior lead Q-waveform criteria (QWC-A) had high specificity (93.3%) but low sensitivity (33.3%) for diagnosing VT, yielding a lower AUC than the Brugada algorithm (0.63 vs 0.75).
Why the study?
Differentiating wide complex tachycardia into VT and SVT with aberration on ECG is often challenging.
Do inferior lead Q-waveform criteria accurately differentiate ventricular tachycardia from supraventricular tachycardia with aberration in patients with wide complex tachycardia compared to the Brugada algorithm?
Observational (n=181)
Do inferior lead Q-waveform criteria accurately differentiate ventricular tachycardia from supraventricular tachycardia with aberration in patients with wide complex tachycardia compared to the Brugada algorithm?
Inferior lead Q-waveform criteria offer high specificity but poor sensitivity for diagnosing ventricular tachycardia, demonstrating lower overall diagnostic accuracy than the established Brugada algorithm.
Answers are grounded in this paper and cite their sources.
QWC-A should not guide wide-complex tachycardia differentiation; leaves open whether refined criteria improve on Brugada in prospective studies.
BACKGROUND: Electrocardiogram (ECG) differentiation of wide complex tachycardia (WCT) into ventricular tachycardia (VT) and supraventricular tachycardia with aberration (SVT-A) is often challenging. OBJECTIVE: To determine if the presence of Q-waveforms (QS, Qr, QRs) in the inferior leads (II, III, aVF) can differentiate VT from SVT-A in a WCT compared to Brugada algorithm. We studied 2 inferior lead criteria namely QWC-A where all the inferior leads had a similar Q wave pattern and QWC-B where only lead aVF had a Q-waveform. METHODS: A total of 181 consecutive cases of WCT were identified, digitally separated into precordial leads and inferior leads and independently reviewed by 2 electrophysiologists. An electrocardiographic diagnosis of VT or SVT-A was assigned based on Brugada and inferior lead algorithms. Results were compared to the final clinical diagnosis. RESULTS: VT was the final clinical diagnosis in 24.9% of ECG cohort (45/181); 75.1% (136/181) were SVT-A. QWC-A and QWC-B had a high specificity (93.3% and 82.8%) and accuracy (78.2% and 71.0%), but low sensitivity (33.3% and 35.6%) in differentiating VT from SVT-A. The Brugada algorithm yielded a sensitivity of 82.2% and specificity of 68.4%. Area under the curve in ROC analysis was highest with Brugada algorithm (0.75, 95% CI 0.69-0.81) followed by QWC-A (0.63, 95% CI 0.56-0.70) and QWC-B (0.59, 95% CI 0.52-0.67). CONCLUSION: QWC-A and QWC-B criteria had poor sensitivity but high specificity in diagnosing VT in patients presenting with WCT. Further research combining this simple criterion with other newer diagnostic algorithms can potentially improve the accuracy of the overall diagnostic algorithm.
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Subramany et al. (2020) conducted an observational in Wide complex tachycardia (WCT) (n=181). Inferior lead Q-waveforms (QWC-A and QWC-B) vs. Brugada algorithm was evaluated on Diagnostic accuracy (Area under the curve) for differentiating VT from SVT-A (AUC 0.63, 95% CI 0.56-0.70). Inferior lead Q-waveform criteria (QWC-A) had high specificity (93.3%) but low sensitivity (33.3%) for diagnosing VT, yielding a lower AUC than the Brugada algorithm (0.63 vs 0.75).
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