Does a stepwise ECG approach using precordial RS complex criteria improve the differential diagnosis of regular wide QRS complex tachycardia compared to current criteria?
A stepwise ECG approach based on the precordial RS complex provides a highly specific method for differentiating ventricular tachycardia from supraventricular tachycardia with aberrant conduction.
Current criteria for the differential diagnosis between supraventricular tachycardia with aberrant conduction and ventricular tachycardia are frequently absent or suggest the wrong diagnosis. The absence of an RS complex in all precordial leads is easily recognizable and highly specific for the diagnosis of ventricular tachycardia. When an RS complex is present in one or more precordial leads, an RS interval of more than 100 msec is highly specific for ventricular tachycardia. This new stepwise approach may prevent diagnostic mistakes.
Brugada et al. (1991) studied this question.