R Wave Peak Time

The R wave peak time (RWPT) was a new criterion developed in 2010 (validated in 2013) and is evaluated in lead II. The beginning of the QRS to the first change in polarity (nadir of S or peak of R) is what should actually be measured. If this time is at least 50ms, then it is likely to be VT.

RWPT may be elevated in conditions other than VT, including left anterior fascicular block, LVH, and LBBB. It is important to remember to use it appropriately when diagnosing VT (for an actual wide complex tachycardia). A normal RWPT is around 40ms.

This is a very simple approach with higher inter-rater reliability compared to the more complex criteria. It has been found to be less sensitive to diagnose VT than Brugada, though somewhat more specific.

Further Reading:

https://litfl.com/vt-versus-svt-ecg-library/

https://litfl.com/r-wave-peak-time-rwpt-ecg-library/

https://en.ecgpedia.org/index.php?title=Approach_to_the_Wide_Complex_Tachycardia

http://hqmeded-ecg.blogspot.com/search/label/wide_complex_tachycardia