Differentiation of Narrow QRS Complex Tachycardia Types Using the 12‐Lead Electrocardiogram

Abstract

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.

Utility of 12‐Lead Electrocardiogram for Differentiating Paroxysmal Supraventricular Tachycardias in Dogs

“…Contrary to human patients where multivariate analysis found ventricular pre‐excitation as an independent predictor of tachycardia mechanism when comparing AVRT, AVNRT, and FAT, 11,14 ventricular pre‐excitation did not discriminate the tachycardia type in our study, although its presence lends support to OAVRT.…”

“…In particular the small number of FAT did not allow us to analyze the electrocardiographic criteria according to the position of accessory pathway or atrial ectopic focus. All FAT analyzed in our study arose from the right atrium, and this is likely to positively influence the results because some left‐sided FAT, although not yet reported in dogs, would produce right superior P wave axis shift similarly to posterior and postero‐septal accessory pathways mediated OAVRT 13–18 . In our sample only 1 anteroseptal accessory pathway maintained a circus movement tachycardia with left inferior retrograde P wave axis.…”

“…1 Twelve-lead surface ECG is considered the 1st step in the diagnosis of SVT in humans, and several studies have validated its utility in differentiating narrow QRS complex tachycardia in patients that have undergone electrophysiologic examination for symptomatic tachyarrhythmias. [9][10][11][12][13][14][15][16][17][18][19] Depending on the study, location of the P wave relative to the QRS complex during tachycardia, P wave axis in the frontal and horizontal plane, PR and RP interval duration, presence of QRS alternation, or repolarization anomalies were good discriminators of tachycardia type. [9][10][11][12][13][14][15][16][17][18][19] Reported overall accuracy in differentiating SVT in humans by means of specific surface ECG criteria ranges between 75 and 97.8%.…”

“…[9][10][11][12][13][14][15][16][17][18][19] Depending on the study, location of the P wave relative to the QRS complex during tachycardia, P wave axis in the frontal and horizontal plane, PR and RP interval duration, presence of QRS alternation, or repolarization anomalies were good discriminators of tachycardia type. [9][10][11][12][13][14][15][16][17][18][19] Reported overall accuracy in differentiating SVT in humans by means of specific surface ECG criteria ranges between 75 and 97.8%. [9][10][11][13][14][15][17][18][19] P wave location, pseudo r 0 wave in lead V1, QRS alternans and ST depression 4 2mm in lead II or elevation !…”

Coronary sinus diameter by echocardiography to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia

“…History of neck pulsations has been proposed as a strong indicator of AVNRT [1], but in our experience this is highly subjective and unreliable. ECG recorded during tachycardia can give various clues, including presence of a pseudo r' wave in V 1 and pseudo s wave in inferior leads, ST depression [13][14][15][16][17], ST elevation in AVR [15,18] or QRS alternans [15,16,19,20]. However, these findings have a low sensitivity, are sometimes subjective and, most importantly, require ECG documentation during tachycardia, which may not be available.…”