Diagnostic Accuracy of Several Electrocardiographic Criteria for the Prediction of Atrioventricular Nodal Reentrant Tachycardia

• Published in: Archives of medical research 2016-07, Vol.47 (5), p.394-400
• Main Authors: Filgueiras Medeiros, Juliana, Nardo-Botelho, Fábio Martins, Felix-Bernardes, Lara Cristina, Hollanda-Oliveira, Lucas, Bassolli de Oliveira-Alves, Lucas, Lúcia-Coutinho, Ênia, Dietrich, Cristiano, Caixeta, Adriano, Almeida-de-Sousa, Jose Marconi, Carlos-Carvalho, Ântonio, Cirenza, Cláudio, Vicenzo-de-Paola, Ângelo Amato
• Format: Article
• Language: English
• Subjects: Ablation; Adolescent; Adult; Aged; Atrioventricular nodal reentrant tachycardia; Child; Child, Preschool; Electrocardiography; Female; Heart Conduction System - physiopathology; Humans; Internal Medicine; Male; Middle Aged; Multivariate Analysis; Prospective Studies; Sensitivity and Specificity; Tachyarrhythmia; Tachycardia; Tachycardia, Atrioventricular Nodal Reentry - diagnosis; Tachycardia, Atrioventricular Nodal Reentry - physiopathology; Young Adult
• ISSN: 0188-4409; 1873-5487
• DOI: 10.1016/j.arcmed.2016.09.003

Background and Aims Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia (SVT) whose diagnosis can be strongly suspected based on the surface eletrocardiogram alone. The purpose of this study is to determine the diagnostic accuracy of several electrocardiographic (ECG) criteria for the prediction of AVNRT. Methods Between November 2010 and January 2014, a total of 256 patients who underwent electrophysiological testing (EP) with regular, paroxysmal and narrow QRS complex tachycardia were prospectively enrolled. We classified the ECG recordings during tachycardia for the presence of the following criteria: a) classical ECG findings of pseudo S wave in inferior leads and/or pseudo r′ wave in lead V1, b) notch in lead aVL, c) no retrograde P waves visible during tachycardia; d) pseudo r′ wave in lead aVR, e) notch in lead D1, f) any deflection after 100 ms of the QRS complex during tachycardia. Results On multivariate analysis, independent predictors of AVNRT diagnosis were female sex (OR 4.17; 95% CI [2.11–8.24]; p 60 years (OR 3.53; 95% CI [1.25–9.96]; p  = 0.017) and the classical ECG criteria (OR 7.41; 95% CI [3.62–15.17]; p 60 years and the classical ECG criteria were the independent predictors of AVNRT diagnosis. Although several of the ECG criteria for AVNRT diagnosis showed acceptable sensitivities and specificities, they do not improve its accuracy.