Author + information
- M. Budanova,
- M. Chmelevsky,
- V. Tikhonenko and
- T. Treshkur
The correct noninvasive differential diagnosis of wide complex arrhythmias is an actual problem in electrophysiology. The most part of current algorithms are based on the detailed analysis of QRS morphology using standard 12-lead ECG. However, it is well known that RR intervals and QRS duration can be used to identify supraventricular arrhythmias (SVA) with aberrant conduction and ventricular arrhythmias (VA). The aim of the study was to investigate a diagnostic value of comprehensive multivariate analysis of RR intervals and QRS duration in differential diagnosis of wide complex arrhythmias.
The study enrolled 108 patients (male – 64 (59,3%), age Me (min; max) – 56,5 (8; 85)) with 279 wide QRS morphologies (min; Me; max – 120; 144; 222 ms) during sinus rhythm. An average (min, max) of 3 (1;8) different wide QRS morphologies were selected from Holter 24-h ECG data (KT Result 3, INCART, RF). Beforehand, a number of 230 (82,4%) and 49 (17,6%) of all wide QRS morphologies were validated as SVA with aberrant conduction and VA, respectively. Five consecutive RR intervals before and after examined wide QRS complex were selected as well as nine QRS morphologies. The durations of all these intervals (ms) were exported to perform a statistical uni- and multivariate analysis followed by evaluation of specifity (Sp) and sensivity (Sn) with 95% CI level (Statistica v.12, Statsoft Inc., USA and SPSS v.23, IBM Corp., USA). A p-value <0.001 was considered as statistically significant.
The duration of SVA (min; Me; max – 120; 132; 179 ms) and VA (min; Me; max – 120; 148; 222 ms) was different (p <0,001; Mann-Whitney U test). ROC analysis showed Sn (95% CI) 59,6% (52,9 – 66,0%) and Sp 79,6% (65,7 – 89,8%) for QRS duration with 140 ms criterion. The following linear discriminant function analysis of all RR intervals and QRS durations classified SVA and VA with Sn 78.3% (72.4 – 83.4%) and Sp 83.7% (70.3 – 92, 7%) with p <0.001.
RR intervals and QRS complex durations criteria have non-significant or low Sn and Sp and cannot be used as separately taken criteria to identify SVA and VA. The results show the fundamental possibility to improve differential diagnosis of wide complex arrhythmias using comprehensive multivariate analysis of RR intervals and QRS durations without other morphological QRS complex characteristics. Further research is needed to evaluate diagnostic value of this new approach.