VT or SVT with Aberrancy?

Basel + Brugada + Vereckei Criteria

Basel + Brugada + Vereckei Criteria

Basel Criteria

1. Clinical high-risk feature for VT present?
Examples prior MI, structural heart disease, prior VT, severe cardiomyopathy
2. Lead II time to first peak > 40 ms?
3. aVR time to first peak > 40 ms?

Brugada Criteria

1. No RS complex in all precordial leads?
2. RS interval > 100 ms in any precordial lead?
3. AV dissociation present?
4. Morphology criteria for VT met?

Vereckei Criteria

1. Initial R wave in aVR?
2. Initial r or q wave in aVR ≥ 40 ms?
3. Notching on the downstroke of a predominantly negative QRS in aVR?
4. Vi/Vt ≤ 1?
Initial ventricular activation slower than terminal portion

Basel Algorithm

  • 2022 multicenter study proposing the Basel algorithm to differentiate VT from SVT with aberrancy in a wide-complex tachycardia
  • VT diagnosed if at least 2 of 3 criteria are present
    • High-risk (MI, EF<35%, ICD/CRT, other high risk structural disease)
    • Lead II time to peak >40ms
    • Lead aVR time to peak >40ms
  • In derivation and validation cohorts the algorithm showed ~92–93% sensitivity and ~89–90% specificity for VT
  • Diagnostic accuracy comparable to Brugada and Vereckei algorithms but significantly faster to apply in usability testing

Brugada Criteria

If any are + then assume VT

  1. Absence of RS complex in all precordial leads (V1–V6)
    • If every QRS is either monophasic R or QS → VT
  2. RS interval >100 ms in any precordial lead
    • Measure from R onset to S nadir
  3. AV dissociation present
    • P waves independent of QRS
  4. Morphologic VT criteria
    • Evaluate QRS morphology in V1/V2 and V6 for VT patterns

Vereckei (aVR) Algorithm

If any are + then assume VT

  1. Initial R wave in aVR
  2. Initial r or q wave in aVR ≥40 ms
  3. Notching on the downstroke of a predominantly negative QRS in aVR
  4. Vi/Vt ≤1 (initial ventricular activation slower than terminal portion)

References

  1. Moccetti, F., Yadava, M., Latifi, Y., Strebel, I., Pavlovic, N., Knecht, S., Asatryan, B., Schaer, B., Kühne, M., & Henrikson, C. A. (2022). Simplified integrated clinical and electrocardiographic algorithm for differentiation of wide QRS complex tachycardia: The Basel algorithm. JACC: Clinical Electrophysiology, 8(7), 831–839. https://doi.org/10.1016/j.jacep.2022.03.017
  2. Brugada, P., Brugada, J., Mont, L., Smeets, J., & Andries, E. W. (1991). A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation, 83(5), 1649–1659. https://doi.org/10.1161/01.CIR.83.5.1649
  3. Vereckei, A., Duray, G., Szénási, G., Altemose, G. T., & Miller, J. M. (2008). New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm, 5(1), 89–98. https://doi.org/10.1016/j.hrthm.2007.09.020
  4. Vereckei, A., Duray, G., Szénási, G., Altemose, G. T., & Miller, J. M. (2007). Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia. European Heart Journal, 28(5), 589–600. https://doi.org/10.1093/eurheartj/ehl473
  5. Katritsis, D. G., & Brugada, J. (2020). Differential diagnosis of wide QRS tachycardias. Arrhythmia & Electrophysiology Review, 9(3), 155–160. https://doi.org/10.15420/aer.2020.20