Wide-complex tachycardia: Continued evaluation of diagnostic criteria

Objective: To evaluate the accuracy of the Brugada algorithm for analysis o f wide-complex tachycardia (WCT) when applied by board-certified emergency physicians and board-certified cardiologists. Methods: A database consistin g of 157 electrocardiograms of WCTs were evaluated in a blinded fashion usi ng the Brugada criteria to determine the presence of ventricular tachycardi a (VT) or supraventricular tachycardia with aberrancy. These results were t hen compared with the electrophysiologically proven diagnosis for each trac ing. Sensitivity and specificity of the Brugada criteria for diagnosis of V T were calculated. Two board-certified emergency physicians and two board-c ertified cardiologists analyzed each tracing, and interobserver agreement w as determined using the kappa statistic. Results: Sensitivity and specifici ty for the determination of VT using the Brugada algorithm were 85% [95% co nfidence interval (95% CI) = 79% to 91%] and 60% (95% CI = 43% to 78%) for cardiologist 1 (C 1) and 91% (95% CI = 86% to 96%) and 55% (95% CI = 37% to 72%) for C 2. Emergency physician (EP 1) achieved a sensitivity of 83% (95 % CI = 78% to 91%) and a specificity of 43% (95% CI = 25% to 59%), while EP 2 attained 79% (95% CI = 73% to 87%) and 70% (95% CI = 51% to 84%), respec tively. The original authors achieved a sensitivity of 98.7% and specificit y of 96.5% when determining VT in their study population. Interobserver agr eement for the emergency physicians and the cardiologists in determining VT was 82% and 81%, respectively. Conclusions: Neither the emergency physicia ns nor the cardiologists were able to achieve a sensitivity or specificity as high as that reported by the original investigators when using the Bruga da algorithm to determine the presence of VT.