Approach to the Wide Complex Tachycardia: Difference between revisions
Jump to navigation
Jump to search
m (→Referenties) |
mNo edit summary |
||
| Line 1: | Line 1: | ||
During wide complex tachycardia (heart rate > 100/min, QRS > 0.12 sec) the differentiation between supraventricular and ventricular origin of the arrhythmia is important to guide therapy. Several algorhythms have been developed to aid in this differentiation. | |||
== The ACC algorhythm <cite>ACC</cite>== | == The ACC algorhythm <cite>ACC</cite>== | ||
[[File:VT_algorythm_en.png|800px|thumb|left|SVT vs VT algorhytm. Adapted from <cite>ACC</cite>]] | [[File:VT_algorythm_en.png|800px|thumb|left|SVT vs VT algorhytm. Adapted from <cite>ACC</cite>]] | ||
{{clr}} | {{clr}} | ||
== Brugada criteria | == Brugada criteria == | ||
{| class="wikitable" width="500px" | {| class="wikitable" width="500px" | ||
! colspan="3" |Brugada criteria ter differentiatie van [[supraventriculaire ritmestoornissen]] (SVT's) van [[ventriculaire ritmestoornissen]] (VT's)<cite>Brug1</cite> | ! colspan="3" |Brugada criteria ter differentiatie van [[supraventriculaire ritmestoornissen]] (SVT's) van [[ventriculaire ritmestoornissen]] (VT's)<cite>Brug1</cite> | ||
Revision as of 11:09, 11 November 2009
During wide complex tachycardia (heart rate > 100/min, QRS > 0.12 sec) the differentiation between supraventricular and ventricular origin of the arrhythmia is important to guide therapy. Several algorhythms have been developed to aid in this differentiation.
The ACC algorhythm [1]
SVT vs VT algorhytm. Adapted from [1]
Brugada criteria
| Brugada criteria ter differentiatie van supraventriculaire ritmestoornissen (SVT's) van ventriculaire ritmestoornissen (VT's)[2] | ||
|---|---|---|
| Zijn er fusie of capture beats? (dit item komt niet uit de Brugada criteria, maar is wel heel specifiek) | Ja? => VT | specificiteit=100% |
| RS complexen afwezig over de voorwand? | Ja? => VT | sensitiviteit=21% specifiteit=100% |
| RS-interval in één van de precordiale afleidingen > 100 msec (bij patient zonder anti-arritmetica)? | Ja? => VT | sensitiviteit=66% specifiteit=98% |
| Is er AV-dissociatie? | Ja? => waarschijnlijk VT (NB AV nodale re-entry kan ook AV-dissociatie geven!) | sensitiviteit=82% specifiteit=98% |
| Morfologische criteria (als bovenstaande criteria geen uitkomst bieden) | ||
| LBTB patroon | ||
| Initiële R breder dan 40ms? | Ja => VT | thumb|100px |
| Slurred of notched neergaand been van S golf in afleiding V1 of V2 | Ja => VT | |
| Begin Q tot nadir QS >60 ms in V1 of V2? | Ja => VT | LR >50:1 |
| Q of QS in V6? | Ja => VT | LR >50:1 |
| thumb|300px | ||
| RBTB patroon | ||
| Monofasische R of qR in V1? | Ja => VT | |
| R hoger dan R' (rabbit-ear sign)? | Ja => VT | LR >50:1 |
| rS in V6? | Ja => VT | LR >50:1 |
| thumb|300px | ||
Voorbeelden
Breedcomplextachycardie. Geen AV dissociatie. RBTB. Lijkt op complex bij SR van zelfde patient. Conclusie: SVT met aberrantie
ECG van zelfde patient als eerste voorbeeld, maar nu in sinusritme. Het QRS complex is nauwelijks gewijzigd
Breedcomplextachycardie. LBTB configuratie. Afwezigheid RS over voorwand. AV-dissociatie: de pijlen wijzen de p-toppen aan. Conclusie: ventrikeltachycardie
Breedcomplextachycardie. LBTB configuratie. Afwezigheid RS over vorwand. AV-dissociatie: de pijlen wijzen de p-toppen aan. Conclusie: ventrikeltachycardie
Referenties
- Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW, Stevenson WG, Tomaselli GF, Antman EM, Smith SC Jr, Alpert JS, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Hiratzka LF, Hunt SA, Jacobs AK, Russell RO Jr, Priori SG, Blanc JJ, Budaj A, Burgos EF, Cowie M, Deckers JW, Garcia MA, Klein WW, Lekakis J, Lindahl B, Mazzotta G, Morais JC, Oto A, Smiseth O, Trappe HJ, and European Society of Cardiology Committee, NASPE-Heart Rhythm Society. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol. 2003 Oct 15;42(8):1493-531. DOI:10.1016/j.jacc.2003.08.013 |
- Brugada P, Brugada J, Mont L, Smeets J, and Andries EW. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. 1991 May;83(5):1649-59. DOI:10.1161/01.cir.83.5.1649 |