{"id":66115,"date":"2026-01-23T19:13:02","date_gmt":"2026-01-23T13:43:02","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=66115"},"modified":"2026-01-23T19:13:04","modified_gmt":"2026-01-23T13:43:04","slug":"vereckei-algorithm-for-differentiating-between-vt-and-svt-with-aberrancy","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/vereckei-algorithm-for-differentiating-between-vt-and-svt-with-aberrancy\/","title":{"rendered":"Vereckei Algorithm for differentiating between VT and SVT with aberrancy"},"content":{"rendered":"<iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/1joyKsg0DxQ?si=wa6Eti2D_4CSfnyR\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n\n<p class=\"wp-block-paragraph\">The <strong>Vereckei Algorithm<\/strong> is a specific diagnostic protocol used in electrocardiography (ECG) to differentiate between <strong>Ventricular Tachycardia (VT)<\/strong> and <strong>Supraventricular Tachycardia (SVT) with aberrancy<\/strong>. It was developed as a simpler, often more accurate alternative to the traditional Brugada criteria. It specifically focuses on the morphology of the <strong>aVR lead<\/strong>, which is often overlooked in standard rhythm analysis.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">The Four Steps of the Algorithm<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The algorithm is designed to be followed sequentially. If any step is met, the diagnosis is <strong>VT<\/strong>, and you stop. If not, you proceed to the next step.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">1. Initial R Wave in aVR<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Look at the very beginning of the QRS complex in lead aVR. If there is an <strong>initial R wave<\/strong> (a positive deflection right at the start), it is VT.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Rationale:<\/strong> In SVT with aberrancy, the impulse typically travels away from aVR, leading to an initial Q wave. A primary impulse starting in the ventricles often moves toward aVR. You may recall that aVR is towards the right shoulder and ventricles lower down.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">2. Initial r or q wave &gt; 40ms<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">If there is an initial small r or q wave, measure its width. If it is <strong>wider than 40ms (one small box)<\/strong>, it is VT.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Rationale:<\/strong> Ventricular-origin beats move slowly through the myocardium initially, creating a wide initial deflection compared to the rapid conduction of the His-Purkinje system.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">3. Notching on the Initial Descending Limb<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Look at the downward stroke of a predominantly negative QRS in aVR. If there is <strong>notching<\/strong> (a &#8220;jagged&#8221; or &#8220;shaggy&#8221; appearance) on that initial descent, it is VT.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">4. Ventricular Activation Velocity Ratio (V<sub>i<\/sub>\/V<sub>t<\/sub> <strong>\u2264<\/strong> 1)<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This is the most technical step. You compare the voltage change (ventricular activation-velocity ratio) during the first 40ms (V<sub>i<\/sub>) and the last 40ms (V<sub>t<\/sub>) of the QRS complex. That will correspond to the ratio of the vertical excursion (in millivolts) recorded during the initial and terminal 40 ms of the QRS complex.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\">If the initial ventricular activation-velocity is less than or equal to the terminal velocity (V<sub>i <\/sub>\/V<sub>t<\/sub> \u2264 1), it is <strong>VT<\/strong>.<\/li>\n\n\n\n<li class=\"\">If the initial ventricular activation-velocity is faster than the terminal velocity (V<sub>i <\/sub>\/V<sub>t<\/sub> > 1), it is <strong>SVT<\/strong>.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Why use Vereckei over Brugada?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">While both are highly effective, many clinicians prefer the Vereckei method for a few reasons:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Single Lead Focus:<\/strong> You only need to look at lead <strong>aVR<\/strong>, whereas Brugada requires looking across all precordial leads (V<sub>1<\/sub> through V<sub>6<\/sub>).<\/li>\n\n\n\n<li class=\"\"><strong>Speed:<\/strong> In emergency settings (like an ER or CCU), analyzing one lead is often faster.<\/li>\n\n\n\n<li class=\"\"><strong>Accuracy:<\/strong> Some studies suggest the &#8220;aVR-only&#8221; approach has higher specificity for identifying VT in patients with pre-existing bundle branch blocks.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Clinical Pearl<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Always remember the &#8220;Golden Rule&#8221; of ACLS: <strong>If the patient is unstable and has a wide-complex tachycardia, treat it as VT regardless of the algorithm.<\/strong> These tools are best utilized when the patient is hemodynamically stable and you have the time for a detailed 12-lead analysis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The original reference for the <strong>Vereckei Algorithm<\/strong> actually consists of two primary papers. While the term is most commonly associated with the 2008 &#8220;aVR-only&#8221; version, it was preceded by a 2007 multistep version.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">1. The aVR-only Algorithm (Most Common)<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This is the four-step protocol focusing exclusively on lead aVR that is widely taught today.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Full Citation:<\/strong> <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18180024\/\" type=\"link\" id=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18180024\/\">Vereckei A, Duray G, Sz\u00e9n\u00e1si G, Altemose GT, Miller JM. <strong>New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia.<\/strong> <em>Heart Rhythm<\/em>. 2008 Jan;5(1):89-98<\/a>.<\/li>\n\n\n\n<li class=\"\"><strong>Key Finding:<\/strong> This study demonstrated that a single-lead (aVR) approach was superior in accuracy to the Brugada criteria, primarily because it eliminated complex morphological interpretations in the precordial leads.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">2. The Original Multistep Algorithm<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before the aVR-only version, Vereckei and colleagues published a broader algorithm that included AV dissociation and other morphological features across the 12-lead ECG.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Full Citation:<\/strong> <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17272358\/\" type=\"link\" id=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17272358\/\">Vereckei A, Duray G, Sz\u00e9n\u00e1si G, Altemose GT, Miller JM. <strong>Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia.<\/strong> <em>European Heart Journal<\/em>. 2007 Mar;28(5):589-600<\/a>.<\/li>\n\n\n\n<li class=\"\"><strong>Key Finding:<\/strong> This paper introduced the <strong>V<sub>i<\/sub>\/V<sub>t<\/sub> ratio<\/strong> (Ventricular Activation Velocity Ratio) as a concept, which later became Step 4 of the 2008 aVR-only algorithm.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Comparison of the Two Papers<\/h3>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><td><strong>Feature<\/strong><\/td><td><strong>2007 Paper (Original)<\/strong><\/td><td><strong>2008 Paper (Simplified)<\/strong><\/td><\/tr><\/thead><tbody><tr><td><strong>Leads Used<\/strong><\/td><td>Full 12-lead ECG<\/td><td><strong>Lead aVR only<\/strong><\/td><\/tr><tr><td><strong>Step 1<\/strong><\/td><td>Search for AV Dissociation<\/td><td>Initial R wave in aVR<\/td><\/tr><tr><td><strong>Step 4<\/strong><\/td><td>V<sub>i<\/sub>\/V<sub>t<\/sub> ratio in any lead<\/td><td>V<sub>i<\/sub>\/V<sub>t<\/sub> ratio in <strong>aVR<\/strong><\/td><\/tr><tr><td><strong>Primary Goal<\/strong><\/td><td>Improve Brugada criteria<\/td><td>Simplify to a single lead<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">If you are citing this for clinical guidelines or an exam, the <strong>2008 Heart Rhythm<\/strong> paper is usually the one intended when people refer to the &#8220;Vereckei aVR Algorithm.&#8221;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Vereckei Algorithm is a specific diagnostic protocol used in electrocardiography (ECG) to differentiate between Ventricular Tachycardia (VT) and Supraventricular Tachycardia (SVT) with aberrancy. It was developed as a simpler, often more accurate alternative to the traditional Brugada criteria. It specifically focuses on the morphology of the aVR lead, which is often overlooked in standard [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":66120,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[9],"tags":[],"class_list":["post-66115","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Vereckei Algorithm for differentiating between VT and SVT with aberrancy - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/vereckei-algorithm-for-differentiating-between-vt-and-svt-with-aberrancy\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Vereckei Algorithm for differentiating between VT and SVT with aberrancy - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"The Vereckei Algorithm is a specific diagnostic protocol used in electrocardiography (ECG) to differentiate between Ventricular Tachycardia (VT) and Supraventricular Tachycardia (SVT) with aberrancy. 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