Brugada Criteria for SVT with Aberrancy vs VT

Author: Michelle Lin, MD
Updated: 2/27/2013

Brugada Criteria for SVT with Aberrancy vs VT

Use this sequential 4-question approach to determine if the ECG reveals SVT with aberrancy vs ventricular tachycardia

If you answer YES to any of these questions, it is ventricular tachycardia.

  1. Is there an ABSENCE of RS complex in all precordial leads (V1-V6?)
  2. Is the R to S interval >100 msec (2.5 boxes) in one precordial lead?
  3. Is there atrioventricular (AV) dissociation?
  4. Is there morphology criteria for VT?

1. Is there an ABSENCE of RS complex in all precordial leads (V1-V6?)

  • YES: VT diagnosis (Sensitivity 21%, Specificity 100%)
  • NO: Move to Question 2

Example of an RS complex

2. Is the R to S interval > 100 msec (2.5 boxes) in one precordial lead?

  • YES: VT diagnosis (Sensitivity 66%, Specificity 98%)
  • NO: Move to Question 3

Example of how to measure the R-S interval

3. Is there Atrioventricular (AV) dissociation?

  • YES: VT diagnosis (Sensitivity 82%, Specificity 98%)
  • *NO: *Move to Question 4

Example of AV dissociation

4. Is there morphology criteria for VT?

Determine if you have a LBBB morphology (dominant S wave in V1) or a RBBB morphology (dominant R wave in V1) then use the appropriate section below to help differentiate. Is there morphology criteria for VT?

  • YES: VT diagnosis (Sensitivity 98.7%, Specificity 96.5%)
  • NO: SVT with aberrance (Sensitivity 96.5%, Specificity 98.7%)

Examples of LBBB and RBBB morphologies

Dr. Stephen Smith's Expert Review

Validations of the Brugada method have not had very good results.

Here is a paper by Isenhour et al that had, for Emergency Physician (EP) #1, 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%).

Verekei has subsequently published 2 criteria which are much easier to apply and performed better than the Brugada criteria:

  1. Heart Journal 2007: Still a bit complex
  2. Heart Rhythm 2008: Uses aVR only

I have a post on differentiating VT and SVT with aberrancy using the Sasaki rule, which has not been validated either, but is even simpler than either Vereckei rule. I use it as a final step if I don’t have the diagnosis from 6 earlier steps. Of course, the diagnosis is not nearly as important as the management, which is easily accomplished by electrical cardioversion.

References

  • Brugada P et al. Circulation. 1991 May;83(5): 1649-59. [PubMed]