Distinguishes between ventricular tachycardia (VT) and Aberrant supraventricular tachycardia (SVT)
Does not differentiate Preexcitation SVT (Antidromic AVRT)

It is relatively simple (though not as accurate as other algorithms)
- If the WCT does not have the appearance of Bundle Branch Block (RBBB, LBBB)

Griffith algorithm: Distinguishes between ventricular tachycardia (VT) and Aberrant supraventricular tachycardia (SVT)

Wide-Complex Tachycardia

Griffith Algorithm differentiates the mechanism of wide-complex tachycardia
Distinguishes ventricular tachycardia (VT) from Aberrant SVT (not from Preexcitation SVT)

The only algorithm that differentiates VT from Preexcitation SVT is the Brugada-Steurer Algorithm

Griffith Algorithm in Clinical Practice

Sensitivity: 95%, Specificity: 64%
Griffith Algorithm
- If the WCT does not have the appearance of Bundle Branch Block (RBBB, LBBB)

Griffith (Bundle Branch Block) algorithm, SVT with RBBB morphology, SVT with LBBB morphology, ventricular tachycardia

Griffith Algorithm

1. Does the WCT have the appearance of RBBB?
- rsR´ (V1)
- RS (V6) and R/S > 1
2. Does the WCT have the appearance of LBBB?
- rS, QS (V1)
  - S wave duration < 70ms (from the beginning of QRS to the peak of S)
  - r wave duration < 30ms
- R wave without Q (V6)
If neither of the above conditions apply
- Then it is ventricular tachycardia (VT)

ECG wide QRS complex tachycardia (ventricular tachycardia), Griffith (Bundle Branch Block) algorithm

Wide-Complex Tachycardia

QRS Width 0.2s
Heart Rate 160/min.
Griffith Algorithm

1. Does the tachycardia have the BPTR pattern? - NO
2. Does the tachycardia have the BĽTR pattern? - NO

This is ventricular tachycardia

ECG wide QRS complex tachycardia (ventricular tachycardia), SVT with RBBB - NO, SVT with LBBB - NO, Griffith (Bundle Branch Block) algorithm

Wide-Complex Tachycardia

QRS Width 0.18s
Heart Rate 166/min.
QRS Alternans

Amplitude of QRS complexes regularly changes

Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - NO
2. Does the tachycardia show BĽTR pattern? - NO

This is ventricular tachycardia

ECG wide QRS complex tachycardia (SVT with RBBB), SVT with RBBB - YES, Griffith (Bundle Branch Block) algorithm

Wide-Complex Tachycardia

QRS Width 0.14s
Heart Rate 212/min.
Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - YES

This is Aberrant SVT with BPTR

supraventricular tachycardia, LBBB morphology

Griffith (Bundle Branch Block) algorithm, ECG differential diagnosis (DDx) broad complex tachycardia, SVT with LBBB morphology

Wide-Complex Tachycardia

QRS Width 0.14s
Heart Rate 150/min.
Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - NO
2. Does the tachycardia show BĽTR pattern? - YES

This is Aberrant SVT with BĽTR

Griffith (Bundle Branch Block) algorithm, DDx broad complex tachycardia, RBBB morphology - YES, SVT with RBBB

Wide-Complex Tachycardia

QRS Width 0.18s
Heart Rate 150/min.
Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - YES

This is Aberrant SVT with BPTR

Griffith criteria, ECG wide QRS complex tachycardia, Ventricular tachycardia, AV dissociation

Wide-Complex Tachycardia

QRS Width 0.18s
Heart Rate 210/min.
Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - NO
2. Does the tachycardia show BĽTR pattern? - YES

According to the Griffith Algorithm, it is Aberrant SVT with BĽTR

However, this algorithm is not as precise as the Brugada Algorithm

The ECG shows AV dissociation (arrows)

which is a key feature of ventricular tachycardia

Griffith criteria, SVT with LBBB morphology, AV dissociation, ventricular tachycardia

Wide-Complex Tachycardia

QRS Width 0.18s
Heart Rate 150/min.
Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - NO
2. Does the tachycardia show BĽTR pattern? - YES

According to the Griffith Algorithm, it is Aberrant SVT with BĽTR

However, this algorithm is not as precise as the Brugada Algorithm

The ECG shows AV Dissociation (arrows)

which is a key feature of ventricular tachycardia

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers

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Griffith Algorithm

Griffith (Bundle Branch Block) algorithm

Aberrant SVT
Griffith Algorithm
Griffith Algorithm in Clinical Practice

Aberrant SVT

Aberrant Conduction

It is a disruption of impulse conduction through the ventricular conduction system
Most commonly involves Bundle Branch Blocks

RBBB (Right Bundle Branch Block)
LBBB (Left Bundle Branch Block)

In Bundle Branch Block, the QRS complex is extended to > 0.12s

Due to prolonged activation of the ventricles from the contralateral bundle

Aberrant Supraventricular Tachycardia (SVT)

It is a tachycardia with a conduction disturbance in the ventricles

Most commonly involves Bundle Branch Block

It is a wide-complex tachycardia

Similar to ventricular tachycardia (VT)

Sometimes it cannot be distinguished from VT

Differentiation uses diagnostic algorithms
One of these is the Griffith Algorithm

Griffith Algorithm

Differentiates wide-complex tachycardia (WCT) (WCT)

Distinguishes between ventricular tachycardia (VT) and Aberrant supraventricular tachycardia (SVT)
Does not differentiate Preexcitation SVT (Antidromic AVRT)

It is relatively simple (though not as accurate as other algorithms)
- If the WCT does not have the appearance of Bundle Branch Block (RBBB, LBBB)

Griffith (Bundle Branch Block) algorithm, Wide complex tachycardia, Orthodrome AV, SVT with aberrant conduction due to the Wolff-Parkinson-White (WPW) syndrome

Wide-Complex Tachycardia

Griffith Algorithm differentiates the mechanism of wide-complex tachycardia
Distinguishes ventricular tachycardia (VT) from Aberrant SVT (not from Preexcitation SVT)

The only algorithm that differentiates VT from Preexcitation SVT is the Brugada-Steurer Algorithm

Griffith Algorithm in Clinical Practice

Sensitivity: 95%, Specificity: 64%
Griffith Algorithm
- If the WCT does not have the appearance of Bundle Branch Block (RBBB, LBBB)

Griffith Algorithm

1. Does the WCT have the appearance of RBBB?
- rsR´ (V1)
- RS (V6) and R/S > 1
2. Does the WCT have the appearance of LBBB?
- rS, QS (V1)
  - S wave duration < 70ms (from the beginning of QRS to the peak of S)
  - r wave duration < 30ms
- R wave without Q (V6)
If neither of the above conditions apply
- Then it is ventricular tachycardia (VT)

Wide-Complex Tachycardia

QRS Width 0.2s
Heart Rate 160/min.
Griffith Algorithm

1. Does the tachycardia have the BPTR pattern? - NO
2. Does the tachycardia have the BĽTR pattern? - NO

This is ventricular tachycardia

Wide-Complex Tachycardia

QRS Width 0.18s
Heart Rate 166/min.
QRS Alternans

Amplitude of QRS complexes regularly changes

Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - NO
2. Does the tachycardia show BĽTR pattern? - NO

This is ventricular tachycardia

Wide-Complex Tachycardia

QRS Width 0.14s
Heart Rate 212/min.
Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - YES

This is Aberrant SVT with BPTR

Wide-Complex Tachycardia

QRS Width 0.14s
Heart Rate 150/min.
Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - NO
2. Does the tachycardia show BĽTR pattern? - YES

This is Aberrant SVT with BĽTR

Wide-Complex Tachycardia

QRS Width 0.18s
Heart Rate 150/min.
Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - YES

This is Aberrant SVT with BPTR

Wide-Complex Tachycardia

QRS Width 0.18s
Heart Rate 210/min.
Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - NO
2. Does the tachycardia show BĽTR pattern? - YES

According to the Griffith Algorithm, it is Aberrant SVT with BĽTR

However, this algorithm is not as precise as the Brugada Algorithm

The ECG shows AV dissociation (arrows)

which is a key feature of ventricular tachycardia

Wide-Complex Tachycardia

QRS Width 0.18s
Heart Rate 150/min.
Griffith Algorithm

1. Does the tachycardia show BPTR pattern? - NO
2. Does the tachycardia show BĽTR pattern? - YES

According to the Griffith Algorithm, it is Aberrant SVT with BĽTR

However, this algorithm is not as precise as the Brugada Algorithm

The ECG shows AV Dissociation (arrows)

which is a key feature of ventricular tachycardia

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers