Brugada Criteria for Ventricular Tachycardia

ECG criteria to help differentiate ventricular tachycardia from supraventricular tachycardia.

The global unit selector only affects unanswered questions
1.Is there an absence of an RS complex in all precordial leads?
2.Is the R to S interval >100 ms in any one precordial lead?
3.Is there Atrioventricular dissociation
4.Is the morphology criteria for VT present in both precordial leads V1-V2 and V6?
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1. Is there an absence of an RS complex in all precordial leads?

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i.e. - All QRS complexes completely upright or downward in precordial leads

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About this Calculator

The Brugada criteria were derived to assist clinicians at the bedside when assessing sick patients with a wide complex tachycardia on their ECG. Specifically, they help differentiate between life-threatening Ventricular Tachycardia and less-serious Supraventricular Tachycardia with aberrancy. The original derivation study was performed by Brugada et al. 1991 and it created a stepwise approach with a 98.7% sensitivity and 96.5% specificity for the detection of ventricular tachycardia.

A subsequent study by Isenhour et al. 2000 attempted to re-validate the criteria and found a decrease in the sensitivity and specificity when used by two emergency physicians and two cardiologists (as low as 79% Sn and 43% Sp). Herbert et al.1996 found that emergency physicians disagreed even when applying the rule 22% of the time.

Despite the inter-rater reliability issues and reduced performance in other follow-up studies, Brugada criteria remain one of the main ECG criteria tools to discern between VT and SVT. Use of this algorithm should be done in caution, as the overall false positive / false negative rates appear to be larger and have led to decreased diagnostic accuracy on follow-up studies.

Variable & Associated Points

  • Is there an absence of an RS complex in all precordial leads?
    i.e. - All QRS complexes completely upright or downward in precordial leads
  • Is the R to S interval >100 ms in any one precordial lead?
    i.e. - Distance between R and S waves in each precordial lead >100ms
  • Is there Atrioventricular dissociation
    i.e. - Are p waves seen at different rates than QRS complexes
  • Is the morphology criteria for VT present in both precordial leads V1-V2 and V6?
    i.e. - VT is frequently a RBBB pattern (upright in V1) or LBBB (downward in V1)
  • If yes to any of these criteria: Ventricular Tachycardia (VT) likely
    If "no" to all four of these criteria: Supraventricular Tachycardia (SVT) likely
    • The original Brugada study found the four criteria together to be 98.7% Sn and 96.5% Sp for detection of VT

References

Brugada P, Brugada J, Mont L, Smeets J, Andries EW.

A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex.

Circulation 1991, 83 (5): 1649-59

Isenhour JL, Craig S, Gibbs M, Littman L, Rose G, Risch R.

Wide-complex tachycardia: continued evaluation of diagnostic criteria.

Academic Emergency Medicine 2000, 7 (7): 769-73

Herbert ME, Votey SR, Morgan MT, Cameron P, Dziukas L.

Failure to agree on the electrocardiographic diagnosis of ventricular tachycardia.

Annals of Emergency Medicine 1996, 27 (1): 35-8

Contributed By:
  • Riley Golby, MD
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