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Differentiating between SVT with aberrancy versus VT can be very difficult. It is crucial to be able to
make this distinction as therapeutic decisions are anchored to this differentiation. Brugada et al prospectively
analyzed 384 patients with VT and 170 patients with SVT with aberrant conduction to see if it was possible to
come up with a simple criteria to help differentiate between the two with high sensitivity and specificity.
The Brugada criteria algorithm involves 4 sequential questions. If at any point, the answer is YES, then it is
VT. (P Brugada et al. 1991)*
1. Is there an absence of an RS complex in all precordial leads?
Yes = VT (Sensitivity 0.21, specificity 1.0)
No = Next question
RS interval > 60 msec (PPV 0.96), as measured from R wave onset to S wave nadir
Following the above stepwise approach can help differentiate between SVT with aberrancy and VT with very
good sensitivity and specificity.
Brugada, P, J Brugada, L Mont, J Smeets, and E W Andries. 1991. A new approach to the differential
diagnosis of a regular tachycardia with a wide QRS complex. Circulation,
no5. http://www.ncbi.nlm.nih.gov/pubmed/2022022