Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway
Abstract
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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An RP cut-off interval of 90 ms has been shown to be useful for surface ECG measurements and can be used if P waves are visible.
“An cut-off interval of 90 ms has been shown to be useful for surface ECG measurements and can be used if P waves are visible, 20”
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 [20]
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2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia
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“This activation sequence produces predominantly negative "sawtooth" flutter waves on the ECG in leads 2, 3, and aVF and a late positive deflection in V1.”
BackgroundInfluentialPage, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H. G., CONTI, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.09.019 · Cited by 100 · see citing works
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“SVT symptom onset often begins in adulthood; in one study in adults, the mean age of symptom onset was 32 18 years of age for AVNRT, versus 23 14 years of age for AVRT.17 In contrast, in a study conducted in pediatric populations, the mean ages of symptom onset of AVRT and AVNRT were 8 and 11 years, respectively.18 In…”
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“…and atrium occur in series as in first ventricle then bypass tract to atrium requiring some time, hence, the RP is generally not shorter than 90 ms. 25 Retrograde conduction involving a slowly conducting decremental pathway (PJRT) results in long RP NCT 26 that is often incessant and can lead to…”
Doğan, H., Özüçelik, D. N., Açıksarı, K., Çağlar, İ. M., Okutan, N., Yazicioglu, M., Avyaci, B. M., Simsek, C., Özaşır, D., Gıray, T. A., et al. (2015) · Europe PMC (PubMed Central) · Cited by 9 · see citing works
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“A cut-off interval of 90 ms has been shown to be useful 12 and is currently used in the diagnostic algorithm of the European Society of Cardiology.”
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‘In the fi eld of observation, chance favours only the prepared mind’
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“We herein report a case of atrial fibrillation (AF) triggered by the Valsalva maneuver performed to terminate AVNRT in a postoperative patient who underwent off-pump coronary artery bypass (OPCAB).”
InfluentialClinical Use of Electrocardiogram
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- Authors
- Letsas, K. P., Weber, R., Siklódy, C. H., Mihas, C. C., Stockinger, J., Blum, T., Kalusche, D., & Arentz, T.
- ORCID
- Venue
- Acta Cardiologica
- Publisher
- Peeters Publishers
- Published
- 2010-04-30
- Volume
- 65
- Issue
- 2
- Pages
- 171-176
- ISSN
- 0001-5385 (ISSN-L)
- OpenAlex
- W2024900917
- Cited by
- 33
- References
- 0
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 1 · 2016: 2 · 2015: 10 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 0.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Cardiologica (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
- atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, concealed accessory pathway, electrocardiographic markers, ST-segment depression, ST-segment elevation, QRS alternans
- MeSH terms
- Adult, Aged, Algorithms, Diagnosis, Differential, Electrocardiography, Female, Heart Conduction System, Humans, Male, Middle Aged, Predictive Value of Tests, Sensitivity and Specificity, Tachycardia, Atrioventricular Nodal Reentry, Cohort Studies, Confidence Intervals, Logistic Models, Odds Ratio, Catheter Ablation, Tachycardia, Reciprocating
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