Brugada Criteria for Ventricular Tachycardia

Why Use

Because current EKG algorithms misdiagnose WCTs 10% of the time ( Grimm 1996 ), knowledge of diagnostic algorithms like the Brugada Criteria is important. The algorithm uses a stepwise approach to provide a sensitive, specific, and accurate way of differentiating SVT with aberrant conduction from VT. Using a stepwise approach prevents errors from being made in the differential diagnosis of tachycardias with a wide QRS complex. Compared to other criteria, this criteria is less prone to mistakes causing potentially fatal outcomes.

When to Use

Patients with wide QRS-complex tachycardias (WCT).

Formula

Pearls / Pitfalls

When none of the VT criteria is present, VT is still present in 15% of cases ( Jastrzebski 2016 ). If there is doubt, the patient should be treated for VT. Using only the first two steps has been shown to yield an 81-96% positive predictive value for VT ( Garner 2013 ). Although Brugada initially reported an accuracy of 98%, four subsequent studies have found accuracies ranging from 77-85%. May have limited agreement among physicians (in one study , up to 22% of emergency physicians disagreed on EKG interpretation using the criteria).

Management

Once the rhythm is identified, treat according to Advanced Cardiac Life Support (ACLS) algorithms .

Critical Actions

Use ACLS-recommended chemical cardioversion for stable patients. For unstable patients (altered mental status, ongoing chest pain, or hypotension), perform electrical cardioversion.

Advice

The one exception to the rule is an Antidromic Atrioventricular Reentrant Tachycardia (AVRT), seen in Wolff-Parkinson White (WPW) Syndrome.