Differential diagnosis of regular, narrow-QRS tachycardias
Abstract
We present an update on clinical and electrophysiological criteria used for the differential diagnosis of regular supraventricular tachycardias. Although several electrocardiographic clues may assist in the differential diagnosis, this is usually accomplished at electrophysiology study, and most often, the differential diagnosis is between atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia due to a concealed accessory pathway, and atrial tachycardia. Atrial and ventricular pacing maneuvers during sinus rhythm or tachycardia have been used with various success rates. In clinical practice, these techniques cannot be applied to all cases, and multiple criteria must be used for the differential diagnosis of narrow-complex tachycardias with atypical characteristics.
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An ECG taken during tachycardia is of key importance for the proper diagnosis of SVT, although it may fail to lead to a specific diagnosis.
“An ECG taken during tachycardia is of key importance for the proper diagnosis of SVT, although it may fail to lead to a specific diagnosis.17”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [17]
Specific but only modestly sensitive ECG criteria for AVNRT, as opposed to atrial tachycardia and AVRT, are a pseudo R deflection in lead V1, a pseudo S wave in the inferior leads, a notch in lead aVL, and a pseudo R in aVR.
“Specific, although modestly sensitive, ECG criteria for AVNRT, as opposed to AT and AVRT, are a pseudo R deflection in lead V 1 and a pseudo S wave in the inferior leads, a notch in lead aVL, and a pseudo R in aVR.17”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [17]
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Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., et al. (2017) · Europace · doi:10.1093/europace/euw301 · Cited by 188 · see citing works
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- Authors
- Katritsis, D. G., & Josephson, M. E.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Katritsis, Demosthenes G.
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2015-07
- Volume
- 12
- Issue
- 7
- Pages
- 1667-1676
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W1990201330
- Cited by
- 89
- References
- 51
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 6 · 2023: 15 · 2022: 12 · 2021: 11 · 2020: 7 · 2019: 9 · 2018: 5 · 2017: 3 · 2016: 5 · 2015: 2
- FWCI
- 0.86
- Type
- journal article
- Language
- en
- Update notices
- erratum (2016-02-01)
- Open access
- closed
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- narrow QRS tachycardia, supraventricular tachycardia, differential diagnosis, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, concealed accessory pathway, atrial tachycardia, electrophysiological study
- MeSH terms
- Diagnosis, Differential, Electrocardiography, Humans, Tachycardia, Atrioventricular Nodal Reentry, Tachycardia, Supraventricular, Electrophysiologic Techniques, Cardiac, Accessory Atrioventricular Bundle
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