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Hanumanthu BKJ, Nazarian S. Atrial overdrive pacing during right bundle branch tachycardia: What is the mechanism? HeartRhythm Case Rep 2024; 10:302-304. [PMID: 38766618 PMCID: PMC11096424 DOI: 10.1016/j.hrcr.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Balaram Krishna J. Hanumanthu
- Section of Cardiac Electrophysiology, Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Cardiovascular Medicine Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Kashou AH, Noseworthy PA, Jentzer JC, Rafie N, Roy AR, Abraham HM, Sang PD, Kronzer EK, Inglis SS, Rezkalla JA, Julakanti RR, Saric P, Asirvatham SJ, Deshmukh AJ, DeSimone CV, May AM. Wide complex tachycardia discrimination tool improves physicians' diagnostic accuracy. J Electrocardiol 2022; 74:32-39. [PMID: 35933848 PMCID: PMC9799284 DOI: 10.1016/j.jelectrocard.2022.07.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/07/2022] [Accepted: 07/23/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Timely and accurate discrimination of wide complex tachycardias (WCTs) into ventricular tachycardia (VT) or supraventricular WCT (SWCT) is critically important. Previously we developed and validated an automated VT Prediction Model that provides a VT probability estimate using the paired WCT and baseline 12-lead ECGs. Whether this model improves physicians' diagnostic accuracy has not been evaluated. OBJECTIVE We sought to determine whether the VT Prediction Model improves physicians' WCT differentiation accuracy. METHODS Over four consecutive days, nine physicians independently interpreted fifty WCT ECGs (25 VTs and 25 SWCTs confirmed by electrophysiological study) as either VT or SWCT. Day 1 used the WCT ECG only, Day 2 used the WCT and baseline ECG, Day 3 used the WCT ECG and the VT Prediction Model's estimation of VT probability, and Day 4 used the WCT ECG, baseline ECG, and the VT Prediction Model's estimation of VT probability. RESULTS Inclusion of the VT Prediction Model data increased diagnostic accuracy versus the WCT ECG alone (Day 3: 84.2% vs. Day 1: 68.7%, p 0.009) and WCT and baseline ECGs together (Day 3: 84.2% vs. Day 2: 76.4%, p 0.003). There was no further improvement of accuracy with addition of the baseline ECG comparison to the VT Prediction Model (Day 3: 84.2% vs. Day 4: 84.0%, p 0.928). Overall sensitivity (Day 3: 78.2% vs. Day 1: 67.6%, p 0.005) and specificity (Day 3: 90.2% vs. Day 1: 69.8%, p 0.016) for VT were superior after the addition of the VT Prediction Model. CONCLUSION The VT Prediction Model improves physician ECG diagnostic accuracy for discriminating WCTs.
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Affiliation(s)
- Anthony H. Kashou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Jacob C. Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nikita Rafie
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Philip D. Sang
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ellen K. Kronzer
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sara S. Inglis
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joshua A. Rezkalla
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Petar Saric
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Adam M. May
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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