Brugada criteria The Brugada criteria are a stepwise approach in which four

criteria for VT are sequentially assessed (figure 13) [29]. If any of the criteria is satisfied, the diagnosis of VT is made, and if none are fulfilled, an SVT is diagnosed. An exception is an antidromic AVRT in WPW syndrome. The steps are as follows: 1. Leads V1-V6 are inspected to detect an RS complex. If there are no RS complexes, concordance is present and the diagnosis of VT can be made (see 'Concordance' above) 2. If an RS complex is present, the interval between the onset of the R wave and the nadir of the S wave (RS interval) is measured. If the longest RS interval in any lead is >100 msec, the diagnosis of VT can be made. 3. If the longest RS interval is <100 msec, the presence or absence of AV dissociation is assessed. If AV dissociation is seen, the diagnosis of VT is made (see 'AV dissociation' above). 4. If the RS interval is <100 msec and AV dissociation cannot clearly be demonstrated, the QRS morphology criteria for V1-positive and V1-negative wide QRS complex tachycardias are considered QRS morphology criteria consistent with VT must be present in leads V1 or V2 and in lead V6 to diagnose VT. If either the V1-V2 or the V6 criteria are not consistent with VT, an SVT is assumed. An RBBB-like pattern QRS polarity is positive in leads V1 and V2 An LBBB-like pattern QRS polarity is negative in leads V1 and V2 This distinction does not, by itself, make the diagnosis, but additional features favor VT in either RBBB-like or LBBB-like WCTs. V1 positive (RBBB) pattern In the patient with a WCT and positive QRS polarity in lead V1, the following associations have been made [6,17,24-27]: Findings in lead V1 A monophasic R or biphasic qR complex in lead V1 favors VT. A triphasic RSR' or RsR' complex (the so-called "rabbit-ear" sign) in lead V1 usually favors SVT. As an exception, if the left peak of the RsR' complex is taller than the right peak, VT is more likely [18,28]. Findings in lead V6 An rS complex (R wave smaller than S wave) in lead V6 favors VT [18]. In contrast, an Rs complex (R wave larger than S wave) in lead V6 favors SVT. V1 negative (LBBB) pattern In the patient with a WCT and negative QRS polarity in lead V1, the following associations have been made [6,17,24-27]: Findings in lead V1 or V2 A broad initial R wave of 40 msec duration or longer in lead V1 or V2 favors VT. In contrast, the absence of an initial R wave or a small initial R wave of less than 40 msec in lead V1 or V2 favors SVT. Two other findings that favor VT are a slurred or notched downstroke of the S wave in lead V1 or V2, and a duration from the onset of the QRS complex to the nadir of the QS or S wave of 60 msec in lead V1 or V2. In contrast, a swift, smooth downstroke of the S wave in lead V1 or V2 with a duration of <60 msec favors SVT. 1