The role of limb-leads criterion in diagnosing the mechanism of wide QRS tachycardias

Abstract

Background: The limb-lead criterion is a simple new standard with high diagnostic value to distinguish the cause of wide QRS tachycardia, easy to apply in emergency conditions.

Methods: A cross-sectional descriptive study of 61 patients with electrocardiogram of wide QRS tachycardia at Cardiovascular Center- Hospital E and Vietnam Heart Institute- Bach Mai Hospital from January 2017 to October -2022. Evaluating the value of limb – leads Criterionand comparing to several other criteria.

Results: In 61 patients, 43 patients with VT, 18 patients with SVT, 54.1% male, history of ischemic heart disease (3.3%), heart failure (11.5%), no history structural cardiovascular disease (83.6%). Mean heart rate was 182, 80 ± 20.58 bpm, average QRS width was 137.89 ± 12.59mms. Sensitivity, specificity, positive predictive value, negative predictive value of Brugada criterionwere 97.7%, 88.9%, 95.5%, 94.1%, respectively; of Pava  criterionwere 53.5%, 88.9%, 92%, 44.4%; of Vereckei criterionwere 60.5%, 100%, 100%, 51.4%; of limb-leads criterion is 86.1%, 83.3%, 92.5%, 71.4%; when combining Limb lead and Pava criteriawere 90.9%, 82.4%, 93%, 77.8%.

Conclusion: The limb-lead criterion is an easy-to-usealgorithm, only using morphology to distinguish wide QRS tachycardias, has high diagnostic value, so it should widely applied in cardiovascular emergency.