Brugada Criteria for Ventricular Tachycardia
ECG criteria to help differentiate ventricular tachycardia from supraventricular tachycardia.
Author / Source: Riley Golby, MD
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
- [1]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
- [2]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
- [3]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
Results
Real-time automated computation
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
- [1]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
- [2]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
- [3]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