The three-step Brugada group algorithm is the only published electrocardiographical (ECG) algorithm for differentiating ventricular tachycardia (VT) from pre-excited tachycardia (PXT) as a cause of regular wide QRS complex tachycardia (WCT). This study aimed to improve the diagnostic accuracy of the Brugada group algorithm.

This study modified the Brugada group algorithm by adding a new aVR lead criterion (initial positive deflection in lead aVR and the QRS complex area above the baseline is greater than the area below the baseline). The Brugada group algorithm and the new, modified four-step algorithm in 300 WCT ECGs (241 VTs, 59 PXTs) was applied. If any of the criteria were fulfilled, VT was diagnosed; if none were fulfilled, a diagnosis of PXT was established.

The test accuracy, VT diagnosis sensitivity, and negative predictive value (NPV) of the new, modified algorithm were significantly greater than that of the Brugada group algorithm: test accuracy 220 of 300 (73%) vs 182 of 300 (61%); sensitivity 73% vs 55% (p<0.001 for both); NPV 40% vs 31% (p=0.0205). The VT diagnosis specificity of the Brugada group algorithm was greater than that of the new, modified algorithm (83% vs 75%; p=0.019). There was no significant difference between the new, modified and Brugada group algorithms in the positive predictive values (92% vs 93%, respectively) for a VT diagnosis, and positive and negative likelihood ratio values (2.87 vs 3.26; 0.36 vs 0.54, respectively).

The new, modified algorithm proved to be more sensitive for the differentiation of VT from PXT than the Brugada group algorithm.