Key result
Specific 12-lead ECG criteria, including a separate P wave, pseudo r' in V1, QRS alternans, preexcitation during sinus rhythm, and ST-segment depression ≥2 mm, independently predicted SVT type.
Why the study?
Do specific 12-lead ECG criteria improve the differentiation of narrow QRS complex tachycardia types in patients with paroxysmal narrow QRS complex tachycardia?
Cross-Sectional (n=120)
Single-blind
No
Do specific 12-lead ECG criteria improve the differentiation of narrow QRS complex tachycardia types in patients with paroxysmal narrow QRS complex tachycardia?
Specific 12-lead ECG criteria, including P wave separation, pseudo r' in V1, and QRS alternans, can independently predict the mechanism of narrow QRS complex tachycardia prior to electrophysiologic study.
BACKGROUND: Previous studies have shown that only 80% of narrow QRS supraventricular tachycardia (SVT) types can be differentiated by standard 12-lead electrocardiographic (ECG) criteria. This study was designed to determine the value of some new ECG criteria in differentiating narrow QRS SVT. METHODS AND RESULTS: 120 ECGs demonstrating paroxysmal narrow QRS complex tachycardia (QRS < or = 0.11 ms and rate > 120 beats/min) were analyzed. Forty atrioventricular reciprocating tachycardia (AVRT), 70 atrioventricular nodal reentrant tachycardia (AVNRT), and 10 atrial tachycardia defined with electrophysiologic study (EPS) consisted the study group. Eight surface ECG criteria were found to be significantly different between tachycardia types by univariate analysis. P waves separate from the QRS complex were observed more frequently in AVRT (70%) and atrial tachycardia (80%). Pseudo r' deflection in lead V(1), pseudo S wave in inferior leads, and cycle length alternans were more common in AVNRT (55, 20, and 6%, respectively). QRS alternans was also present during AVRT (28%). ST-segment depression (> or = 2 mm) or T-wave inversion, or both, were present more often in AVRT (60%) than in AVNRT (27%). During sinus rhythm, manifest preexcitation was observed more often in patients with AVRT (42%). When a P wave was present, RP/PR interval ratio > 1 was more common in atrial tachycardia (90%). By multivariate analysis, presence of a P wave separate from the QRS complex, pseudo r' deflection in lead V(1), QRS alternans, preexcitation during sinus rhythm, ST-segment depression > 2 mm or T-wave inversion, or both, were independent predictors of tachycardia type. CONCLUSIONS: Several new ECG criteria may be useful in differentiation of SVT types. Prediction of mechanism prior to EPS may provide additional benefits concerning the fluoroscopic exposure time and cardiac catheterization procedure.
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Erdinler et al. (2002) conducted a cross-sectional in Narrow QRS complex tachycardia (n=120). 12-lead ECG criteria vs. Electrophysiologic study (EPS) diagnosis was evaluated on Independent predictors of tachycardia type (AVRT, AVNRT, atrial tachycardia). Specific 12-lead ECG criteria, including a separate P wave, pseudo r' in V1, QRS alternans, preexcitation during sinus rhythm, and ST-segment depression ≥2 mm, independently predicted SVT type.
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