Tachyarrhythmia discriminator for implantable cardioverter-defibrillators in bundle branch block

Kapoor, Ridhima; Tyagi, Sudhi; Dohmen, C.; Oujiri, James; Roth, James A.; Rubenstein, Jason; Berger, Marcie

doi:10.1016/j.hrthm.2020.04.031

Cited by 1 publication

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“…Nevertheless, initial slow propagation due to a distance difference outside of the His‐Purkinje system was demonstrated. The time interval from a far‐field RV lead to a near‐field RV lead using the classic conduction pathway (AV node, His, Purkinje) was short in patients with SVT, but prolonged in patients with VT (Kapoor et al., 2020). Similar to SVT, the changes in early propagation speed in pre‐ET and VT might be affected not only by the distance difference from the His‐Purkinje system but also by myocardial dysfunction or scar formation near the pathway tract.…”

Section: Discussionmentioning

confidence: 99%

Discrimination between ventricular tachycardia and wide‐QRS preexcited tachycardia

Lee

2024

Noninvasive Electrocardiol

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BackgroundTo develop a new algorithm to differentiate ventricular tachycardia (VT) from preexcited tachycardia (pre‐ET) according to left bundle branch block (LBBB) and right bundle branch block (RBBB) patterns.MethodsThis study included 67 electrocardiograms (ECGs) with VT and 63 ECGs with pre‐ET, collected from our hospital and through PubMed. Of those, 64 were allocated to the derivation cohort and the rest to the validation cohort. The diagnoses of the ECGs were confirmed using an electrophysiological study. Parameters and classifiers from prior algorithms along with the propagation speeds in the early portion of the QRS complex (initial deflection index) in leads V1, V6, aVR, II, and III were manually measured. The performance of the new algorithm was compared with that of prior algorithms.ResultsThe initial deflection index in lead III was the strongest predictor of pre‐ET in LBBB‐pattern wide‐QRS tachycardia (p = 0.003, AUC 0.805). The initial deflection index in lead V1 was the most powerful predictor of pre‐ET in RBBB‐pattern wide‐QRS tachycardia (p = 0.001, AUC 0.848). Compared to earlier algorithms, those using the initial deflection indexes: lead III in LBBB patterns (cutoff value >0.3) and lead V1 in RBBB patterns (cutoff value ≤0.48), demonstrated superior performance in screening VT, with AUC values of 0.828. The initial deflection indexes proved effective as discriminators between VT and pre‐ET in the validation cohort.ConclusionsIn LBBB‐pattern wide‐QRS tachycardia, the early propagation speed of pre‐ET was faster than that in VT. Conversely, in RBBB‐pattern wide‐QRS tachycardia, it was slower.

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Section: Discussionmentioning

confidence: 99%

Discrimination between ventricular tachycardia and wide‐QRS preexcited tachycardia

Lee

2024

Noninvasive Electrocardiol

View full text Add to dashboard Cite

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Tachyarrhythmia discriminator for implantable cardioverter-defibrillators in bundle branch block

Cited by 1 publication

References 14 publications

Discrimination between ventricular tachycardia and wide‐QRS preexcited tachycardia

Discrimination between ventricular tachycardia and wide‐QRS preexcited tachycardia

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