{"id":66371,"date":"2026-03-05T15:58:56","date_gmt":"2026-03-05T10:28:56","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=66371"},"modified":"2026-03-05T15:58:57","modified_gmt":"2026-03-05T10:28:57","slug":"the-vt-algorithm-mega-guide-brugada-vereckei-and-pava-criteria","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/the-vt-algorithm-mega-guide-brugada-vereckei-and-pava-criteria\/","title":{"rendered":"\u00a0The &#8220;VT Algorithm&#8221; Mega-Guide: Brugada, Vereckei, and Pava Criteria"},"content":{"rendered":"<iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/uoL1mzyWP14?si=GPTepmxPg7zbw4kv\" 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\">Distinguishing Ventricular Tachycardia (VT) from Supraventricular Tachycardia with aberrancy (SVT-A) is a critical skill in cardiology. When faced with a Regular Wide Complex Tachycardia (WCT), the three important diagnostic algorithms are <strong>Brugada<\/strong>, <strong>Vereckei<\/strong>, and <strong>Pava<\/strong>.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">1. The Brugada Algorithm<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The Brugada criteria is a four-step sequential &#8220;decision tree.&#8221; If any step is positive, you stop and diagnose <strong>VT<\/strong>. If none are met, the diagnosis is <strong>SVT<\/strong>.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><td><strong>Step<\/strong><\/td><td><strong>Question<\/strong><\/td><td><strong>If YES&#8230;<\/strong><\/td><td><strong>If NO&#8230;<\/strong><\/td><\/tr><\/thead><tbody><tr><td><strong>1<\/strong><\/td><td>Absence of an <strong>RS complex<\/strong> in all precordial leads (V1\u2013V6)?<\/td><td><strong>VT<\/strong><\/td><td>Move to Step 2<\/td><\/tr><tr><td><strong>2<\/strong><\/td><td>Is the <strong>RS interval<\/strong> &gt; 100 ms in any precordial lead?<\/td><td><strong>VT<\/strong><\/td><td>Move to Step 3<\/td><\/tr><tr><td><strong>3<\/strong><\/td><td>Is there <strong>AV Dissociation<\/strong> (P waves independent of QRS)?<\/td><td><strong>VT<\/strong><\/td><td>Move to Step 4<\/td><\/tr><tr><td><strong>4<\/strong><\/td><td>Are morphology criteria for VT present in <strong>V1-V2<\/strong> and <strong>V6<\/strong>?<\/td><td><strong>VT<\/strong><\/td><td><strong>SVT<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Note on Step 2:<\/strong> The RS interval is measured from the start of the R-wave to the deepest part (nadir) of the S-wave.<\/li>\n\n\n\n<li class=\"\"><strong>Note on Step 4:<\/strong> Look for &#8220;rabbit ears&#8221; in V1 where the left ear (R) is taller than the right (R&#8217;), or a QS complex in V6.<\/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\">2. The Vereckei Algorithm (aVR Lead)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Vereckei simplified the process by focusing primarily on <strong>Lead aVR<\/strong>. Because aVR is essentially &#8220;looking down&#8221; from the right shoulder into the heart, VT (which often travels &#8220;up&#8221; from the apex) looks very different from SVT.<\/p>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li class=\"\"><strong>Initial R wave:<\/strong> Is there an initial R wave in aVR? If yes -> <strong>VT<\/strong>.<\/li>\n\n\n\n<li class=\"\"><strong>Initial r or q width:<\/strong> Is the width of the initial r or q wave > 40 ms? If yes -> <strong>VT<\/strong>.<\/li>\n\n\n\n<li class=\"\"><strong>Notching:<\/strong> Is there notching on the initial downstroke of a predominantly negative QRS? If yes -> <strong>VT<\/strong>.<\/li>\n\n\n\n<li class=\"\"><strong>Ventricular Activation Velocity Ratio (Vi\/Vt):<\/strong> Compare the voltage change in the first 40 ms (Vi) to the last 40 ms (Vt). If Vi\/Vt \u2264 1 (slow initial entry) -> <strong>VT<\/strong>.<\/li>\n<\/ol>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">3. The Pava Criterion (Lead II)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/doi.org\/10.1016\/j.hrthm.2010.03.001\" type=\"link\" id=\"https:\/\/doi.org\/10.1016\/j.hrthm.2010.03.001\">Pava et al<\/a>. introduced an &#8220;ultra-simple&#8221; method focusing on <strong>Lead II<\/strong>. It is based on the principle that VT originates in the muscle (slow conduction) while SVT uses the specialized conduction system (fast initial conduction).<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Criterion:<\/strong> Measure the <strong>R-wave Peak Time (RWPT)<\/strong> in Lead II.<\/li>\n\n\n\n<li class=\"\"><strong>Measurement:<\/strong> From the very beginning of the QRS complex to the first peak (or nadir, if negative).<\/li>\n\n\n\n<li class=\"\"><strong>Threshold:<\/strong> If the <strong>RWPT \u2265 50 ms<\/strong>, the diagnosis is <strong>VT<\/strong>.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Distinguishing Ventricular Tachycardia (VT) from Supraventricular Tachycardia with aberrancy (SVT-A) is a critical skill in cardiology. When faced with a Regular Wide Complex Tachycardia (WCT), the three important diagnostic algorithms are Brugada, Vereckei, and Pava. 1. The Brugada Algorithm The Brugada criteria is a four-step sequential &#8220;decision tree.&#8221; If any step is positive, you stop [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":66372,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[9],"tags":[],"class_list":["post-66371","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>\u00a0The &quot;VT Algorithm&quot; Mega-Guide: Brugada, Vereckei, and Pava Criteria - 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\/the-vt-algorithm-mega-guide-brugada-vereckei-and-pava-criteria\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u00a0The &quot;VT Algorithm&quot; Mega-Guide: Brugada, Vereckei, and Pava Criteria - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"Distinguishing Ventricular Tachycardia (VT) from Supraventricular Tachycardia with aberrancy (SVT-A) is a critical skill in cardiology. When faced with a Regular Wide Complex Tachycardia (WCT), the three important diagnostic algorithms are Brugada, Vereckei, and Pava. 1. 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