A systematic review and meta-analysis, in the Heart, compared 21 available ECG algorithms across 22 studies, involving 3,483 patients (2,706 with RVOT and 777 with LVOT). The analysis assessed sensitivity, specificity, diagnostic odds ratios (DORs), and an overall superiority index.

Results revealed that the weighted hybrid score algorithm outperformed all others, showing the highest diagnostic accuracy with a superiority index of 21.2 and a DOR of 275.8. Its pooled sensitivity was 0.83, and its specificity was 0.92. It suggests that it may be the most reliable tool for differentiating LVOT from RVOT arrhythmias. The Earliest onset or peak/nadir in lead V2 algorithm demonstrated the lowest diagnostic performance.