Uma das grandes dificuldades do emergencista é quando um paciente chega com uma taquicardia de QRS largo no Pronto Socorro. E agora? Seria uma Taquicardia Ventricular ou uma Taquicardia Supraventricular? Existem diversos algoritmos para auxiliar na diferenciação e dentre os principais podemos citar o de Brugada, Vereckei e PAVA.
No período de janeiro de 2010 a dezembro de 2014, na Universidade de Basel (Suíca), foram analisados retrospectivamente 206 pacientes que realizaram estudo eletrofisiológico devido a taquicardia com QRS largo (153 Taquicardia ventricular e 53 Taquicardia supraventricular). Todos os ECGs foram avaliados de acordo com 1) Basel Algoritmo 2) Algoritmo de Brugada 3)Algoritmo Vereckei.
Basel Algoritmo apresentou valores elevados de sensibilidade e especificidade (se comparando a outros algoritmos) porém com menor tempo de análise.
Critérios do Basel Algoritmo
Esse novo algoritmo se baseia em 03 critérios, sendo o primeiro clínico e os outros dois eletrocardiográficos. Na presença de 02 ou mais critérios o diagnóstico de Taquicardia Ventricular é realizado. Se encontrar apenas um critério ou nenhum, o diagnóstico é de Taquicardia Supraventricular.
Critérios:
- Presença de Cardiopatia Estrutural (História de Infarto do Miocárdio Prévio, Fração de Ejeção menor que 35% e presença de Device como CDI ou Ressincronizador);
- Tempo até o pico em D2 maior que 40ms;
- Tempo até o pico em AVR maior que 40ms;
Referência:
Moccetti et al. Simplified Integrated Clinical and Electrocardiographic Algorithm for Differentiation of Wide QRS Complex Tachycardia -The Basel Algorithm. JACC: Clinical Electrophysiology Vol. 8, No. 7, 2022. July 2022: 831–839832
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