A 55-year-old woman presents with palpitations. 12-lead ECG shows a regular wide-complex tachycardia at 160 bpm. The Brugada criteria for distinguishing VT from SVT with aberrancy include which finding as MOST specific for VT?
- A Absence of an RS complex in all precordial leads ✓
- B QRS width >120 ms
- C RS interval >100 ms in any precordial lead
- D Left axis deviation
Correct answer: A. Absence of an RS complex in all precordial leads
Explanation
The Brugada algorithm for wide complex tachycardia begins with the question: is there an RS complex in any precordial lead? If NO (ie. all-concordant positive or negative complexes, or only monophasic QRS in all leads) → VT is diagnosed with high specificity (98%). If RS is present, proceed to check RS interval >100 ms, AV dissociation, and morphological criteria. Absence of any RS in all precordial leads (step 1) is the most specific initial feature. QRS >120 ms alone is not specific for VT as it occurs in SVT with bundle branch block.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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