Differential diagnosis of wide XXXX : comparison of two electrocardiographic algorithms.

@entity1 @entity591 @entity4710 @entity67 @entity346
AIMS: This study's aim is to compare the ability of two ECG criteria to differentiate @entity67 ( @entity67 ) from @entity4710 ( @entity4710 ): Brugada et al. [ @entity346 ( @entity346 ) leads] and Vereckei et al. [frontal plane (FP), specifically aVR lead], having electrophysiological study (EPS) as gold standard. After comparing, suggestions for better diagnosis of @entity591 ( @entity591 ) in emergency situations were made. METHODS AND RESULTS: Fifty-one consecutive @entity1 with 12-lead ECG registered during EPS-induced regular @entity591 were selected. Each ECG was split into two parts: @entity346 (V1-V6) and FP (D1-D3, aVR, aVL, and aVF), randomly distributed to three observers, blinded for EPS diagnosis and complementary ECG plane, resulting in total 306 ECG analyses. Observers followed the four steps of both algorithms, counting time-to-diagnosis. Global sensitivity, specificity, percentage of incorrect diagnoses, and step-by-step positive/negative likelihood ratios (+LR and -LR) were calculated. Kaplan-Meier curve was plotted for final time-to-diagnosis. Inter-observer agreement was assessed with kappa-statistic. Global sensitivity was similarly high in FP and @entity346 algorithms (89.2 vs. 90.1%), and incorrect classifications were 27.4 vs. 24.7%. Forty-eight correct analyses by Vereckei criteria took 9.13 s to diagnose @entity67 in the first step, showing that first step was fast, with high +LR, generating nearly conclusive pre- (72.6%) to post-test (98.0%) changes for @entity67 probability. CONCLUSION: Both algorithms as a whole are similar for diagnosis of WTC; however, the first step of Vereckei (initial R in aVR) is a simple, reproducible, accurate, and fast tool to use. The negativity of this step requires a 'holistic' approach to distinguish @entity67 from @entity4710 .
