| Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway. | |
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MedLine Citation:
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PMID: 20458824 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The present study aimed to evaluate the diagnostic value of specific ECG markers in the differentiation of common type atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) via a concealed accessory pathway. METHODS: One hundred and ten ECGs with paroxysmal narrow QRS complex, short RP tachycardia were evaluated. Subjects with overt ventricular pre-excitation during sinus rhythm were excluded from the study. The mechanism of arrhythmia was established during the electrophysiological study and confirmed by the efficacy of radiofrequency ablation. RESULTS: Of the 110 patients, 74 displayed common type AVNRT and 36 AVRT. Predictors of AVNRT were the presence of pseudo r'-waves in lead V1 [sensitivity 39.19%; specificity 97.14%; positive predictive value (PPV) 96.67%; negative predictive value (NPV) 43.04%] and pseudo S-waves in inferior leads (sensitivity 28.38%; specificity 94.29%; PPV 91.30%; NPV 38.37%). In the setting of visible P-waves, an RP interval < or =90 ms favoured the diagnosis of AVNRT (sensitivity 57.14%; specificity 80.65%). Predictors of AVRT were QRS alternans (sensitivity 50%; specificity 89.19%; PPV 69.23%; NPV 78.57%) as well as ST-segment alterations during tachycardia. The overall sensitivity, specificity, PPV and NPV of ST-segment depression for discriminating AVRT from AVNRT were 97.22%, 58.11%, 53.03%, 97.73%, respectively. Similarly, the sensitivity, specificity, PPV and NPV of ST-segment elevation in lead aVR were 94.44%, 58.11%, 52.31%, and 95.56%, respectively. Multiple logistic regression analysis showed that ST-segment depression [(odds ratio (OR): 12.67, 95% confidence interval (CI): 1.77-90.81, P = 0.011)] and QRS alternans (OR: 9.43, 95% CI: 1.38-64.37, P = 0.022) displayed the highest predictive ability favouring the diagnosis of AVRT. CONCLUSIONS: Twelve-lead ECG parameters may help to differentiate the mechanism of supraventricular tachycardia prior to the ablation procedure. |
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Authors:
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Konstantinos P Letsas; Reinhold Weber; Claudia Herrera Siklody; Constantinos C Mihas; Jochem Stockinger; Thomas Blum; Dietrich Kalusche; Thomas Arentz |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Acta cardiologica Volume: 65 ISSN: 0001-5385 ISO Abbreviation: Acta Cardiol Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-05-12 Completed Date: 2010-06-11 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0370570 Medline TA: Acta Cardiol Country: Belgium |
Other Details:
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Languages: eng Pagination: 171-6 Citation Subset: IM |
Affiliation:
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Division of Rhythmology, Herz-Zentrum, Bad Krozingen, Germany. k.letsas@mail.gr |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Algorithms Catheter Ablation Cohort Studies Confidence Intervals Diagnosis, Differential Electrocardiography* / methods Female Heart Conduction System / physiopathology* Humans Logistic Models Male Middle Aged Odds Ratio Predictive Value of Tests Sensitivity and Specificity Tachycardia, Atrioventricular Nodal Reentry / diagnosis*, physiopathology, surgery Tachycardia, Reciprocating / diagnosis*, physiopathology |
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