Arq. Bras. Cardiol. 2021; 116(3): 464-465

Simplified Algorithm for Differential Diagnosis of Tachycardias with Wide QRS. Is this the Best Way to Train Young Doctors?

Enrique Indalécio Pachón Mateo

DOI: 10.36660/abc.20201344

This Short Editorial is referred by the Research article "Validation of a Simple Electrocardiographic Algorithm for Detection of Ventricular Tachycardia".

To make the correct diagnosis of ventricular tachycardia in an emergency room (ER), with little time for decision-making and based only on the electrocardiogram is a challenge that depends on a lot of preparation by the doctor. Any instrument that facilitates and streamlines this process, especially increasing the degree of accuracy, is also worthy of praise, especially considering that the physician on duty is not always a cardiologist, or even less likely an arrhythmologist, sufficiently trained to make an accurate diagnosis.

An episode of ventricular tachycardia, supraventricular tachycardia (in a patient with a previous conduction disorder or with a conduction aberrancy) and supraventricular tachycardia caused by anomalous bundles may show similar electrocardiographic tracings, which are sometimes very difficult to differentiate, making the medical decision a risk to the patient’s life. To make this differentiation possible, several algorithms have been created that use electrocardiographic signals to assist and allow the correct diagnosis to be made and, consequently, to establish the adequate treatment, as in the case of the Brugada algorithm which is widely known (and that in fact is a combination of Brugada and Wellens criteria), as well as Vereckei and Pava criteria among others. All the created algorithms have sensitivity and specificity (S/E) variables that make them more or less accurate; however, in the same proportion, these algorithms can be simpler, or more complex (depending on the operator’s better training and greater time to reach the diagnosis).

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