Effective discrimination of wide QRS complex tachycardia with a new algorithm - the Prelocalization Series Algorithm

• Published in: BMC cardiovascular disorders Vol. 25; no. 1; pp. 134 - 11
• Main Authors: Ni, Honglin, Huang, Yue, Pan, Xiaowei, Zhang, Xiaoli, Wan, Zhiyong, Zhai, Changlin, Pan, Haihua
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25.02.2025; BioMed Central; BMC
• Subjects: Accuracy; Action Potentials; Adult; Aged; Algorithms; Cardiac arrhythmia; Diagnosis; Diagnosis, Differential; Earliest ventricular origin; EKG; Electrocardiogram; Electrocardiography; Electrophysiology; Female; Heart Rate; His-purkinje system; Humans; Male; Methods; Middle Aged; Physiological aspects; Pre-Excitation Syndromes - diagnosis; Pre-Excitation Syndromes - physiopathology; Predictive Value of Tests; Preexcited tachycardia; Reproducibility of Results; Retrospective Studies; Signal Processing, Computer-Assisted; Statistical analysis; Tachycardia; Tachycardia, Supraventricular - diagnosis; Tachycardia, Supraventricular - physiopathology; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - physiopathology; Wide QRS complex tachycardia; Young Adult; China; Zhejiang China; Earliest ventricular origin; Preexcited tachycardia; Wide QRS complex tachycardia; His-purkinje system
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-025-04583-1

Electrocardiogram (ECG) plays a crucial role in the correct diagnosis of wide QRS complex tachycardia (WCT). Objective To evaluate the diagnostic value of a new WCT discrimination algorithm, herein referred to as the Prelocalization Series Algorithm. A retrospective analysis of 181 ECGs from WCT patients was conducted using the Prelocalization Series Algorithm, Brugada Series Algorithm, and Vereckei Series Algorithm. Initially, the algorithms were used to differentiate between ventricular tachycardia (VT) and supraventricular tachycardia (SVT). Subsequently, the VT cases preliminarily judged were further differentiated into VT or preexcited tachycardia (PXT). The results were compared with the clinically confirmed diagnoses to observe the diagnostic value of the three algorithms. The Prelocalization Series Algorithm demonstrated higher AUC values (0.90 vs. 0.73 vs. 0.69), sensitivity (0.91 vs. 0.61 vs. 0.50), and accuracy (0.90 vs. 0.71 vs. 0.65) in diagnosing VT compared to the Brugada Series Algorithm and Vereckei Series Algorithm. The Prelocalization Algorithm's single process (without differentiating between VT and PXT) also showed higher AUC values (0.79 vs. 0.67 vs. 0.63), sensitivity (0.96 vs. 0.91 vs. 0.76), specificity (0.62 vs. 0.44 vs. 0.49), and accuracy (0.82 vs. 0.72 vs. 0.65) than the Brugada Four-Step Method and aVR lead method. The accuracy of the Prelocalization Series Algorithm in diagnosing VT (0.90 vs. 0.82) was higher than its single process algorithm.With all differences being statistically significant (all P < 0.05). The Prelocalization Series Algorithm is an effective new algorithm for discriminating WCT and can be attempted for diagnosing VT, SVT, and PXT. Not applicable.