Diagnostic accuracy of different ECG-based algorithms in wide QRS complex tachycardia: a systematic review and meta-analysis

BMJ Open. 2023 Jul 24;13(7):e069273. doi: 10.1136/bmjopen-2022-069273.


Objective: Several ECG-based algorithms have been proposed to enhance the effectiveness of distinguishing Wide QRS complex tachycardia (WCT), but a comprehensive comparison of their accuracy is still lacking. This meta-analysis aimed to assess the diagnostic precision of various non-artificial intelligence ECG-based algorithms for WCT.

Design: Systematic review with meta-analysis.

Data sources: Electronic databases (PubMed, MEDLINE, the Cochrane Library, and Web of Science) are searched up to May 2022.

Eligibility criteria for selecting studies: All studies reporting the diagnostic accuracy of different ECG-based algorithms for WCT are included. The risk of bias in included studies is assessed using the Cochrane Collaboration's risk of bias tools.

Data extraction and synthesis: Two independent reviewers extracted data and assessed risk of bias. Data were pooled using random-effects model and expressed as mean differences with 95% CIs. Heterogeneity was calculated by the I2 method. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was applied to assess the internal validity of the diagnostic studies.

Results: In total, 467 studies were identified, and 14 studies comprising 3966 patients were included, involving four assessable ECG-based algorithms: the Brugada algorithm, Vereckei-pre algorithm, Vereckei-aVR algorithm and R wave peak time of lead II (RWPT-II) algorithm. The overall sensitivity was 88.89% (95% CI: 85.03 to 91.86), with a specificity of 70.55% (95% CI: 62.10 to 77.79) and a diagnostic OR (DOR) of 19.17 (95% CI: 11.45 to 32.10). Heterogeneity of the DOR was 89.1%. The summary sensitivity of each algorithm was Brugada 90.25%, Vereckei-pre 94.80%, Vereckei-aVR 90.35% and RWPT-II 78.15%; the summary specificity was Brugada 64.02%, Vereckei-pre 75.40%, Vereckei-aVR 60.88% and RWPT-II 88.30% and the summary DOR was Brugada 16.48, Vereckei-pre 60.70, Vereckei-aVR 14.57 and RWPT-II 27.00.

Conclusions: ECG-based algorithms exhibit high sensitivity and moderate specificity in diagnosing WCT. A combination of Brugada or Vereckei-aVR algorithm with RWPT-II could be considered to diagnose WCT.

Prospero registration number: CRD42022344996.

Keywords: accident & emergency medicine; cardiology; pacing & electrophysiology.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Algorithms
  • Arrhythmias, Cardiac / diagnosis
  • Diagnosis, Differential
  • Electrocardiography* / methods
  • Humans
  • Sensitivity and Specificity
  • Tachycardia* / diagnosis