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Vol. 69. Issue 3.
Pages 354 (March 2016)
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Vol. 69. Issue 3.
Pages 354 (March 2016)
Letter to the Editor
DOI: 10.1016/j.rec.2015.11.022
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Echocardiographic Diagnosis of Ventricular Tachycardia: Is There a Problem With Clinical and Electrocardiographic Diagnostic Criteria? Response
Taquicardia ventricular diagnosticada por ecocardiografía: ¿fallan los criterios diagnósticos clínicos y electrocardiográficos? Respuesta
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Paul M. Preza
Servicio de Cardiología, Hospital Nacional Arzobispo Loayza, Lima, Perú
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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.8–10 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.

References
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P.M. Preza.
Diagnóstico de taquicardia ventricular por ecocardiografía.
Rev Esp Cardiol., 68 (2015), pp. 892
[2]
M. Dancy, A.J. Camm, D. Ward.
Misdiagnosis of chronic recurrent ventricular tachycardia.
Lancet., 326 (1985), pp. 320-323
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M.H. Raitt, E.G. Renfroe, A.E. Epstein, J.H. McAnulty, P. Mounsey, J.S. Steinberg, et al.
“Stable” ventricular tachycardia is not a benign rhythm: insights from the antiarrhythmics versus implantable defibrillators (AVID) registry.
Circulation., 103 (2001), pp. 244-252
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Specificity of the wide QRS complex tachycardia algorithms in recipients of cardiac resynchronization therapy.
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Wide-complex tachycardia: continued evaluation of diagnostic criteria.
Acad Emerg Med., 7 (2000), pp. 769-773
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Vereckei criteria as a diagnostic tool amongst emergency medicine residents to distinguish between ventricular tachycardia and supra-ventricular tachycardia with aberrancy.
J Cardiol., 59 (2012), pp. 307-312
[7]
B.S.N. Alzand, H.J.G.M. Crijns.
Diagnostic criteria of broad QRS complex tachycardia: decades of evolution.
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[8]
A. Rückel, W. Kasper, N. Treese, B. Henkel, T. Pop, T. Meinertz.
Atrioventricular dissociation detected by suprasternal M-mode echocardiography: a clue to the diagnosis of ventricular tachycardia.
Am J Cardiol., 54 (1984), pp. 561-563
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P.K. Jacobsen, S. Modi, D. McCarty, G.J. Klein, P. Leong-Sit.
Identification of atrio-ventricular relationship with echocardiography – a useful tool to diagnose ventricular tachycardia.
Resuscitation., 83 (2012), pp. e212-e213
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D. Manyari, P. Ko, G. Sajad, D. Boughner, W. Kostuk, G. Klein.
A simple echocardiographic method to detect atrioventricular dissociation.
Chest., 81 (1982), pp. 67-73
Copyright © 2015. Sociedad Española de Cardiología
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