Wie nützlich sind die Algorithmen zur Differentialdiagnostik der monomorphen Tachykardien mit breitem QRS-Komplex in kardiologischen Notfällen?

Abstract

This review gives an integrated summary of the three old and two new ECG algorithms for the differential diagnosis of monomorphic regular tachycardias with broad QRS complex. Several studies have provided evidence that a ventricular tachycardia was diagnosed correctly by doctors on call and emergency physicians only in 35-50% of cases. Whether an algorithm may really improve diagnosis in everyday clinical practice and whether the algorithms are feasible for physicians, has not yet been clarified.The algorithms possess a high sensitivity of 88-95%, but only a satisfactory specificity of 73-80%. The values of all algorithms are similar. In the hands of physicians with little experience, the incidence of correct diagnoses is likely to be markedly lower. The algorithms have considerable limitations, especially with regard to the application of the "morphology criteria". As the nondetection of a ventricular tachycardia can have fatal consequences for the patient, any tachycardia with broad QRS complex should be treated as ventricular tachycardia in emergencies. In hemodynamically stable patients, the administration of adenosine for diagnostic purposes should immediately lead to a correct diagnosis. Based on the study situation, a schematic representation for the differential diagnosis has been created which follows very simple ECG criteria identifiable by any physician.

Kardiale Notfälle: neue Lösungen für alte Probleme

“…Eine neue Lösung für alte Probleme zeigen zunächst Himmrich et al auf [2] Das Hauptproblem, dessen sich die interventionelle Kardiologie annimmt, bleibt jedoch die koronare Herzerkrankung. Insbesondere beim ST-Hebungsinfarkt (STEMI) hat sich die Akut-PCI (perkutane Koronarintervention) als Therapie der Wahl herausgestellt.…”