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The Vereckei algorithm is another option for an algorithm to diagnose VT vs SVT with aberrancy. It is a highly sensitive but not as specific algorithm. The initial algorithm introduced 2 new concepts: initial R wave in aVR and Vi/Vt (ratio of voltage change in initial 40ms of QRS compared to voltage change in terminal 40ms of QRS). However, this algorithm actually takes longer than the Brugada algorithm.
A newer, more simplified version of the Vereckei algorithm was created utilizing only lead aVR. This algorithm focuses on the changes in conduction during the beginning and ending portions of the QRS complex. This is because SVT with aberrancy will initially have greater changes (impulses originate in the conduction system) and then slow down due to bundle branch block, metabolic, or toxic effects. In VT, the initial portion of the depolarization will be slower/have smaller changes as it originates in the myocardium.
Source: Current Algorithms for the Diagnosis of Wide complex QRS Algorithms
Schematic showing why an initial R wave in aVR makes physiologic sense
Example:
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