Independent predictive accuracy of classical electrocardiographic criteria in the diagnosis of paroxysmal atrioventricular reciprocating tachycardias in patients without pre-excitation

被引:12
作者
Gonzalez-Torrecilla, Esteban [1 ]
Almendral, Jesus [1 ]
Arenal, Angel [1 ]
Atienza, Felipe [1 ]
del Castillo, Silvia [1 ]
Fernandez-Aviles, Francisco [1 ]
机构
[1] Hosp Gen Gregorio Maranon, Arrhythmia Control Unit, Dept Cardiol, Madrid 28007, Spain
来源
EUROPACE | 2008年 / 10卷 / 05期
关键词
supraventricular tachycardia; electrocardiogram; diagnosis;
D O I
10.1093/europace/eun084
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims In patients without pre-excitation, the differential diagnosis of paroxysmal atrioventricular (AV) reciprocating tachycardias consists mainly of atrioventricular nodal re-entrant tachycardias (AVNRTs) and AV reciprocating tachycardias (AVRTs) through a concealed bypass. Our purpose was to validate the diagnostic accuracy of a predictive logistic model using classical electrocardiographic (ECG) criteria. Methods and results We included 470 patients who underwent an electrophysiological study for paroxysmal, regular, and narrow-QRS complex tachycardia without pre-excitation in sinus rhythm. The ECG recordings were reviewed for the presence of the following: (i) pseudo r' deflection (V1) and/or pseudo s-wave (inferior leads), (ii) identifiable P-wave after the QRS complex, (iii) QRS alternans, and (iv) repolarization abnormalities during tachycardia. We performed a cross-validation method using the first 300 patients to develop a logistic model to predict the tachycardia diagnosis. The model was validated through the remaining 170 patients. The invasive study demonstrated AVNRT in 314 patients and AVRT in 156 patients. The presence of pseudo r' deflection and/or pseudo s-wave, a visible P-wave after the QRS complex, and QRS alternans were selected by a stepwise multiple logistic regression analysis as predictors for the diagnosis of AVNRT. The application of the model in the validation group showed a shrinkage prediction factor of 3%. Diagnostic probabilities for both tachycardia mechanisms depending on every combination of selected ECG criteria were > 75% in 70% of the patients. Conclusion The presence of pseudo r' deflection and/or pseudo s-wave, an identifiable P-wave after the QRS, and QRS alternans during tachycardia permit us to derive a reliable logistic model to predict the mechanism of paroxysmal AVRT in patients without pre-excitation. Precise probabilities for a correct diagnosis associated with every combination of those classical ECG criteria are presented.
引用
收藏
页码:624 / 628
页数:5
相关论文
共 16 条
[1]   Differentiating atrioventricular nodal reentrant tachycardia from tachycardia via concealed accessory pathway [J].
Arya, A ;
Kottkamp, H ;
Piorkowski, C ;
Schirdewahn, P ;
Tanner, H ;
Kobza, R ;
Dorszewski, A ;
Gerds-Li, JH ;
Hindricks, G .
AMERICAN JOURNAL OF CARDIOLOGY, 2005, 95 (07) :875-878
[2]   DIFFERENTIAL-DIAGNOSIS OF TACHYCARDIA WITH NARROW QRS COMPLEX (SHORTER THAN 0.12 SECOND) [J].
BAR, FW ;
BRUGADA, P ;
DASSEN, WRM ;
WELLENS, HJJ .
AMERICAN JOURNAL OF CARDIOLOGY, 1984, 54 (06) :555-560
[3]   ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias -: Executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) [J].
Blomström-Lundqvist, C ;
Scheinman, MM ;
Aliot, EM ;
Alpert, JS ;
Calkins, H ;
Camm, AJ ;
Campbell, WB ;
Haines, DE ;
Kuck, KH ;
Lerman, BB ;
Miller, DD ;
Shaeffer, CW ;
Stevenson, WG ;
Tomaselli, GF ;
Antman, EM ;
Smith, SC ;
Alpert, JS ;
Faxon, DP ;
Fuster, V ;
Gibbons, RJ ;
Gregoratos, G ;
Hiratzka, LF ;
Hunt, SA ;
Jacobs, AK ;
Russell, RO ;
Priori, SG ;
Blanc, JJ ;
Budaj, A ;
Burgos, EF ;
Cowie, M ;
Deckers, JW ;
Garcia, MAA ;
Klein, WW ;
Lekakis, J ;
Lindahl, B ;
Mazzotta, G ;
Morais, JCA ;
Oto, A ;
Smiseth, O ;
Trappe, HJ .
CIRCULATION, 2003, 108 (15) :1871-1909
[4]   Differentiation of narrow QRS complex tachycardia types using the 12-lead electrocardiogram [J].
Erdinler, I ;
Okmen, E ;
Oguz, E ;
Akyol, A ;
Gurkan, K ;
Ulufer, T .
ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, 2002, 7 (02) :120-126
[5]   Usefulness of ST-segment elevation in lead aVR during tachycardia for determining the mechanism of narrow QRS complex tachycardia [J].
Ho, YL ;
Lin, LY ;
Lin, JL ;
Chen, MF ;
Chen, WJ ;
Lee, YT .
AMERICAN JOURNAL OF CARDIOLOGY, 2003, 92 (12) :1424-1428
[6]   Electrocardiographic differentiation of typical atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway in children [J].
Jaeggi, ET ;
Gilljam, T ;
Bauersfeld, U ;
Chiu, C ;
Gow, R .
AMERICAN JOURNAL OF CARDIOLOGY, 2003, 91 (09) :1084-1089
[7]  
Josephson ME., 2002, CLIN CARDIAC ELECTRO, P425
[8]   DIFFERENTIATION OF PAROXYSMAL NARROW QRS COMPLEX TACHYCARDIAS USING THE 12-LEAD ELECTROCARDIOGRAM [J].
KALBFLEISCH, SJ ;
ELATASSI, R ;
CALKINS, H ;
LANGBERG, JJ ;
MORADY, F .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 21 (01) :85-89
[9]   VALUE OF THE 12-LEAD ELECTROCARDIOGRAM IN DISCRIMINATING ATRIOVENTRICULAR NODAL RECIPROCATING TACHYCARDIA FROM CIRCUS MOVEMENT ATRIOVENTRICULAR TACHYCARDIA UTILIZING A RETROGRADE ACCESSORY PATHWAY [J].
KAY, GN ;
PRESSLEY, JC ;
PACKER, DL ;
PRITCHETT, ELC ;
GERMAN, LD ;
GILBERT, MR .
AMERICAN JOURNAL OF CARDIOLOGY, 1987, 59 (04) :296-300
[10]   MAGNITUDE OF ST SEGMENT DEPRESSION DURING PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA [J].
KIM, YN ;
SOUSA, J ;
ELATASSI, R ;
CALKINS, H ;
LANGBERG, JJ ;
MORADY, F .
AMERICAN HEART JOURNAL, 1991, 122 (05) :1486-1487