BackgroundTo develop a new algorithm to differentiate ventricular tachycardia (VT) from preexcited tachycardia (pre‐ET) according to left bundle branch block (LBBB) and right bundle branch block (RBBB) patterns.MethodsThis study included 67 electrocardiograms (ECGs) with VT and 63 ECGs with pre‐ET, collected from our hospital and through PubMed. Of those, 64 were allocated to the derivation cohort and the rest to the validation cohort. The diagnoses of the ECGs were confirmed using an electrophysiological study. Parameters and classifiers from prior algorithms along with the propagation speeds in the early portion of the QRS complex (initial deflection index) in leads V1, V6, aVR, II, and III were manually measured. The performance of the new algorithm was compared with that of prior algorithms.ResultsThe initial deflection index in lead III was the strongest predictor of pre‐ET in LBBB‐pattern wide‐QRS tachycardia (p = 0.003, AUC 0.805). The initial deflection index in lead V1 was the most powerful predictor of pre‐ET in RBBB‐pattern wide‐QRS tachycardia (p = 0.001, AUC 0.848). Compared to earlier algorithms, those using the initial deflection indexes: lead III in LBBB patterns (cutoff value >0.3) and lead V1 in RBBB patterns (cutoff value ≤0.48), demonstrated superior performance in screening VT, with AUC values of 0.828. The initial deflection indexes proved effective as discriminators between VT and pre‐ET in the validation cohort.ConclusionsIn LBBB‐pattern wide‐QRS tachycardia, the early propagation speed of pre‐ET was faster than that in VT. Conversely, in RBBB‐pattern wide‐QRS tachycardia, it was slower.

中文翻译：

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室性心动过速与宽QRS波预激心动过速的鉴别

背景开发一种新的算法，根据左束支传导阻滞 (LBBB) 和右束支传导阻滞 (RBBB) 模式区分室性心动过速 (VT) 和预激性心动过速 (pre-ET)。方法本研究包括 67 例伴有 VT 和预激性心动过速的心电图 (ECG)。 63 份 ET 前心电图，从我们医院通过 PubMed 收集。其中，64 人被分配到推导队列，其余的被分配到验证队列。心电图的诊断通过电生理学研究得到证实。手动测量先前算法的参数和分类器，以及导联 V1、V6、aVR、II 和 III 中 QRS 波群早期部分（初始偏转指数）的传播速度。将新算法的性能与现有算法的性能进行了比较。结果 III 导联的初始偏转指数是 LBBB 型宽 QRS 心动过速中 ET 前最强的预测因子（p= 0.003，AUC 0.805）。 V1 导联的初始偏转指数是 RBBB 型宽 QRS 心动过速中 ET 前最有力的预测因子（p= 0.001，AUC 0.848）。与早期算法相比，使用初始偏转指标：LBBB 模式中的导联 III（截止值 >0.3）和 RBBB 模式中的导联 V1（截止值≤0.48）的算法在筛查 VT 方面表现出优越的性能，AUC 值为 0.828。在验证队列中，初始偏转指数被证明可以有效区分 VT 和 ET 前。结论 在 LBBB 型宽 QRS 心动过速中，ET 前的早期传播速度快于 VT。相反，在 RBBB 型宽 QRS 心动过速中，速度较慢。