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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Brugada Criteria for Ventricular Tachycardia

    Distinguishes ventricular tachycardia from supraventricular tachycardia.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with wide QRS-complex tachycardias (WCT).

    • 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).

    • 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.

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    Next Steps
    Evidence
    Creator Insights

    Advice

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

    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.

    Content Contributors
    • John Dayton, MD
    About the Creator
    Dr. Pedro Brugada
    Are you Dr. Pedro Brugada?
    Content Contributors
    • John Dayton, MD