Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul;8(7):831-839.
doi: 10.1016/j.jacep.2022.03.017. Epub 2022 May 25.

Simplified Integrated Clinical and Electrocardiographic Algorithm for Differentiation of Wide QRS Complex Tachycardia: The Basel Algorithm

Federico Moccetti  1 , Mrinal Yadava  2 , Yllka Latifi  3 , Ivo Strebel  4 , Nikola Pavlovic  5 , Sven Knecht  4 , Babken Asatryan  6 , Beat Schaer  4 , Michael Kühne  4 , Charles A Henrikson  2 , Frank-Peter Stephan  4 , Stefan Osswald  4 , Christian Sticherling  4 , Tobias Reichlin  7
Affiliations
Free article

Simplified Integrated Clinical and Electrocardiographic Algorithm for Differentiation of Wide QRS Complex Tachycardia: The Basel Algorithm

Federico Moccetti et al. JACC Clin Electrophysiol. 2022 Jul.
Free article

Abstract

Background: Prompt differential diagnosis of wide QRS complex tachycardia (WCT) is crucial to patient management. However, distinguishing ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with wide QRS complexes remains problematic, especially for nonelectrophysiologists.

Objectives: This study aimed to develop a simple-to-use algorithm with integration of clinical and electrocardiographic (ECG) parameters for the differential diagnosis of WCT.

Methods: The 12-lead ECGs of 206 monomorphic WCTs (153 VT, 53 SVT) with electrophysiology-confirmed diagnoses were analyzed. In the novel Basel algorithm, VT was diagnosed in the presence of at least 2 of the following criteria: 1) clinical high risk features; 2) lead II time to first peak >40 ms; and 3) lead aVR time to first peak >40 ms. The algorithm was externally validated in 203 consecutive WCT cases (151 VT, 52 SVT). Its' diagnostic performance and clinical applicability were compared with those of the Brugada and Vereckei algorithms.

Results: The Basel algorithm showed a sensitivity, specificity, and accuracy of 92%, 89%, and 91%, respectively, in the derivation cohort and 93%, 90%, and 93%, respectively, in the validation cohort. There were no significant differences in the performance characteristics between the 3 algorithms. The evaluation of the clinical applicability of the Basel algorithm showed similar diagnostic accuracy compared with the Brugada algorithm (80% vs 81%; P = 1.00), but superiority compared with the Vereckei algorithm (72%; P = 0.03). The Basel algorithm, however, enabled a faster diagnosis (median 36 seconds vs 105 seconds for the Brugada algorithm [P = 0.002] and 50 seconds for the Vereckei algorithm [P = 0.02]).

Conclusions: The novel Basel algorithm based on simple clinical and ECG criteria allows for a rapid and accurate differential diagnosis of WCT.

Keywords: ECG; algorithm; cardiac arrhythmia; sudden cardiac death; supraventricular tachycardia; ventricular tachycardia; wide QRS complex tachycardia.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures Dr Schaer has received personal fees from Medtronic. Dr Kühne has received grants from the Swiss National Science Foundation, the Swiss Heart Foundation, Daiichi-Sankyo, Bayer, Pfizer BMS, and Boston Scientific; and has received personal fees from Bayer, Boehringer Ingelheim, Pfizer BMS, Daiichi-Sankyo, Medtronic, Biotronik, Boston Scientific, and Johnson & Johnson, all outside the submitted work. Dr Henrikson has received fellowship support from Abbott, Boston Scientific, and Medtronic; and has served as chair of the clinical endpoints committee for Biotronik. Dr Sticherling has received grants from Biosense-Webster; and has received lecture fees from Abbott, Medtronic, Biosense-Webster, Boston Scientific, Microport, and Biotronik. Dr Reichlin has received speaker/consulting honoraria or travel support from Abbott/SJM, AstraZeneca, Brahms, Bayer, Biosense-Webster, Biotronik, Boston-Scientific, Daiichi-Sankyo, Medtronic, Pfizer BMS, and Roche, all for work outside the submitted study; and has received support for his institution’s fellowship program from Abbott/SJM, Biosense-Webster, Biotronik, Boston-Scientific, and Medtronic for work outside the submitted study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

  • Ockham's Razor and Bayes Theorem at Work.
    Brugada P. Brugada P. JACC Clin Electrophysiol. 2022 Jul;8(7):840-842. doi: 10.1016/j.jacep.2022.04.006. JACC Clin Electrophysiol. 2022. PMID: 35863809 No abstract available.

LinkOut - more resources