Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2016;69:354 - Vol. 69 Num.03 DOI: 10.1016/j.rec.2015.11.022

Echocardiographic Diagnosis of Ventricular Tachycardia: Is There a Problem With Clinical and Electrocardiographic Diagnostic Criteria? Response

Paul M. Preza a,

a Servicio de Cardiología, Hospital Nacional Arzobispo Loayza, Lima, Perú

Refers to

Echocardiographic Diagnosis of Ventricular Tachycardia: Is There a Problem With Clinical and Electrocardiographic Diagnostic Criteria?
Pablo J. Sánchez-Millán, Manuel Molina-Lerma, Luis Tercedor-Sánchez, Miguel Álvarez-López
Rev Esp Cardiol. 2016;69:353-4
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Article

To the Editor,

I am grateful for the interest shown in the published echocardiography images1 and agree with the authors that hemodynamic stability in some patients during episodes of ventricular tachycardia can lead to a misdiagnosis of wide-QRS supraventricular tachycardia2; it is of the utmost importance to differentiate between ventricular and supraventricular origin because of the worse prognosis of ventricular tachycardia.3 Nonetheless, the many electrocardiographic algorithms in use have not achieved 100% sensitivity or specificity4; moreover, even widely accepted tools such as the Brugada and Vereckei criteria do not achieve the sensitivity or specificity of the original reports when applied by emergency physicians or even cardiologists.5, 6 Furthermore, the specificity of some criteria can be reduced in patients with complete left bundle branch block, as well as in patients with a structurally normal heart.4, 7

When present, atrioventricular dissociation is one of the most specific practical criteria for differential diagnosis of ventricular vs supraventricular tachycardia,7 and some authors have therefore suggested the potential diagnostic usefulness of echocardiography.8, 9, 10 The presented case provides an example.

The authors correctly state that clinical and electrocardiographic criteria can establish a diagnosis of ventricular tachycardia in most cases. However, we should keep in mind that resident and emergency physicians have to reach a diagnosis when confronted with acute cases of patients with hemodynamically stable wide-QRS tachycardia; with the echocardiography images presented, my intention was to remind them that they have an additional tool at their disposal for the diagnosis of atrioventricular dissociation.

Bibliography

1. Preza PM. Diagnóstico de taquicardia ventricular por ecocardiografía. Rev Esp Cardiol. 2015;68:892.
2. Dancy M, Camm AJ, Ward D. Misdiagnosis of chronic recurrent ventricular tachycardia. Lancet. 1985;326:320-3.
3. Raitt MH, Renfroe EG, Epstein AE, McAnulty JH, Mounsey P, Steinberg JS, et al. “Stable”ventricular tachycardia is not a benign rhythm: insights from the antiarrhythmics versus implantable defibrillators (AVID) registry. Circulation. 2001;103:244-52.
4. Jastrzebski M, Kukla P, Czarnecka D, Kawecka-Jaszcz K. Specificity of the wide QRS complex tachycardia algorithms in recipients of cardiac resynchronization therapy. J Electrocardiology. 2012;45:319-26.
5. Isenhour JL, Craig S, Gibbs M, Littmann L, Rose G, Risch R. Wide-complex tachycardia: continued evaluation of diagnostic criteria. Acad Emerg Med. 2000;7:769-73.
6. Baxi RP, Hart KW, Vereckei A, Miller J, Chung S, Chang W, et al. Vereckei criteria as a diagnostic tool amongst emergency medicine residents to distinguish between ventricular tachycardia and supra-ventricular tachycardia with aberrancy. J Cardiol. 2012;59:307-12.
7. Alzand BSN, Crijns HJGM. Diagnostic criteria of broad QRS complex tachycardia: decades of evolution. Europace. 2011;13:465-72.
8. Rückel A, Kasper W, Treese N, Henkel B, Pop T, Meinertz T. Atrioventricular dissociation detected by suprasternal M-mode echocardiography: a clue to the diagnosis of ventricular tachycardia. Am J Cardiol. 1984;54:561-3.
9. Jacobsen PK, Modi S, McCarty D, Klein GJ, Leong-Sit P. Identification of atrio-ventricular relationship with echocardiography –a useful tool to diagnose ventricular tachycardia. Resuscitation. 2012;83:e212-3.
10. Manyari D, Ko P, Sajad G, Boughner D, Kostuk W, Klein G. A simple echocardiographic method to detect atrioventricular dissociation. Chest. 1982;81:67-73.

1885-5857/© 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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