A new electrocardiographic algorithm using retrograde P waves for differentiating atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway

Ching T. Tai, Shih A. Chen, Chern E. Chiang, Shih Huang Lee, Zu C. Wen, Chuen Wang Chiou, Kwo Chang Ueng, Yi J. Chen, Wen Chung Yu, Mau Song Chang

研究成果: 雜誌貢獻文章

53 引文 (Scopus)

摘要

Objectives. The purpose of this study was to use an electrocardiographic (ECG) algorithm, derived from the results of radiofrequency ablation, to discriminate atrioventricular node reentrant tachycardia (AVNRT) from atrioventricular reciprocating tachycardia (AVRT) and to localize a concealed accessory pathway, prospectively. Background. Information about ECG criteria for differentiating AVNRT from AVRT is limited and has not been confirmed by surgical or catheter ablation. Methods. Four hundred six ECGs (obtained from 406 different patients) that demonstrated narrow QRS complex (1 or pseudo S wave in inferior leads, or both, were examined, and the results were confirmed by radiofrequency catheter ablation. The initial 226 ECGs were analyzed to develop a stepwise algorithm, and the subsequent 180 ECGs were prospectively evaluated by the new algorithm. Results. The presence of a pseudo r' wave in lead V1 or a pseudo S wave in leads II, III, aVF indicated anterior-type AVNRT with an accuracy of 100%. With the difference of RP' intervals in leads V1 and III >20 ms, posterior-type AVNRT could be differentiated from AVRT utilizing a posteroseptal pathway with a sensitivity of 71% (95% confidence interval [CI] 55% to 89%), a specificity of 87% (95% CI 67% to 97%) and a positive predictive value of 75% (95% CI 56% to 91%). According to the polarity of retrograde P waves in leads V1, II, III, aVF and I during AVRT, the concealed accessory pathway could be localized to one of the nine regions on the atrioventricular annuli with an accuracy of 75% (for a right midseptal pathway) to 93.8% (for a left posterior pathway). Overall, the new algorithm had an accuracy of 97.8% in discriminating AVNRT from AVRT and 88.1% in localizing a concealed accessory pathway, prospectively. Prediction was incorrect in only 15 patients (9.1%). Conclusions. The new ECG algorithm derived from the analysis of retrograde P waves during tachycardia could provide a criterion for differential diagnosis between AVNRT and AVRT and for predicting the location of concealed accessory pathways.

原文英語
頁(從 - 到)394-402
頁數9
期刊Journal of the American College of Cardiology
29
發行號2
DOIs
出版狀態已發佈 - 二月 1997
對外發佈Yes

指紋

Reciprocating Tachycardia
Accessory Atrioventricular Bundle
Atrioventricular Node
Tachycardia
Electrocardiography
Catheter Ablation
Confidence Intervals
Differential Diagnosis

ASJC Scopus subject areas

  • Nursing(all)

引用此文

A new electrocardiographic algorithm using retrograde P waves for differentiating atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway. / Tai, Ching T.; Chen, Shih A.; Chiang, Chern E.; Lee, Shih Huang; Wen, Zu C.; Chiou, Chuen Wang; Ueng, Kwo Chang; Chen, Yi J.; Yu, Wen Chung; Chang, Mau Song.

於: Journal of the American College of Cardiology, 卷 29, 編號 2, 02.1997, p. 394-402.

研究成果: 雜誌貢獻文章

Tai, Ching T. ; Chen, Shih A. ; Chiang, Chern E. ; Lee, Shih Huang ; Wen, Zu C. ; Chiou, Chuen Wang ; Ueng, Kwo Chang ; Chen, Yi J. ; Yu, Wen Chung ; Chang, Mau Song. / A new electrocardiographic algorithm using retrograde P waves for differentiating atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway. 於: Journal of the American College of Cardiology. 1997 ; 卷 29, 編號 2. 頁 394-402.
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title = "A new electrocardiographic algorithm using retrograde P waves for differentiating atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway",
abstract = "Objectives. The purpose of this study was to use an electrocardiographic (ECG) algorithm, derived from the results of radiofrequency ablation, to discriminate atrioventricular node reentrant tachycardia (AVNRT) from atrioventricular reciprocating tachycardia (AVRT) and to localize a concealed accessory pathway, prospectively. Background. Information about ECG criteria for differentiating AVNRT from AVRT is limited and has not been confirmed by surgical or catheter ablation. Methods. Four hundred six ECGs (obtained from 406 different patients) that demonstrated narrow QRS complex (1 or pseudo S wave in inferior leads, or both, were examined, and the results were confirmed by radiofrequency catheter ablation. The initial 226 ECGs were analyzed to develop a stepwise algorithm, and the subsequent 180 ECGs were prospectively evaluated by the new algorithm. Results. The presence of a pseudo r' wave in lead V1 or a pseudo S wave in leads II, III, aVF indicated anterior-type AVNRT with an accuracy of 100{\%}. With the difference of RP' intervals in leads V1 and III >20 ms, posterior-type AVNRT could be differentiated from AVRT utilizing a posteroseptal pathway with a sensitivity of 71{\%} (95{\%} confidence interval [CI] 55{\%} to 89{\%}), a specificity of 87{\%} (95{\%} CI 67{\%} to 97{\%}) and a positive predictive value of 75{\%} (95{\%} CI 56{\%} to 91{\%}). According to the polarity of retrograde P waves in leads V1, II, III, aVF and I during AVRT, the concealed accessory pathway could be localized to one of the nine regions on the atrioventricular annuli with an accuracy of 75{\%} (for a right midseptal pathway) to 93.8{\%} (for a left posterior pathway). Overall, the new algorithm had an accuracy of 97.8{\%} in discriminating AVNRT from AVRT and 88.1{\%} in localizing a concealed accessory pathway, prospectively. Prediction was incorrect in only 15 patients (9.1{\%}). Conclusions. The new ECG algorithm derived from the analysis of retrograde P waves during tachycardia could provide a criterion for differential diagnosis between AVNRT and AVRT and for predicting the location of concealed accessory pathways.",
author = "Tai, {Ching T.} and Chen, {Shih A.} and Chiang, {Chern E.} and Lee, {Shih Huang} and Wen, {Zu C.} and Chiou, {Chuen Wang} and Ueng, {Kwo Chang} and Chen, {Yi J.} and Yu, {Wen Chung} and Chang, {Mau Song}",
year = "1997",
month = "2",
doi = "10.1016/S0735-1097(96)00490-1",
language = "English",
volume = "29",
pages = "394--402",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "2",

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TY - JOUR

T1 - A new electrocardiographic algorithm using retrograde P waves for differentiating atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway

AU - Tai, Ching T.

AU - Chen, Shih A.

AU - Chiang, Chern E.

AU - Lee, Shih Huang

AU - Wen, Zu C.

AU - Chiou, Chuen Wang

AU - Ueng, Kwo Chang

AU - Chen, Yi J.

AU - Yu, Wen Chung

AU - Chang, Mau Song

PY - 1997/2

Y1 - 1997/2

N2 - Objectives. The purpose of this study was to use an electrocardiographic (ECG) algorithm, derived from the results of radiofrequency ablation, to discriminate atrioventricular node reentrant tachycardia (AVNRT) from atrioventricular reciprocating tachycardia (AVRT) and to localize a concealed accessory pathway, prospectively. Background. Information about ECG criteria for differentiating AVNRT from AVRT is limited and has not been confirmed by surgical or catheter ablation. Methods. Four hundred six ECGs (obtained from 406 different patients) that demonstrated narrow QRS complex (1 or pseudo S wave in inferior leads, or both, were examined, and the results were confirmed by radiofrequency catheter ablation. The initial 226 ECGs were analyzed to develop a stepwise algorithm, and the subsequent 180 ECGs were prospectively evaluated by the new algorithm. Results. The presence of a pseudo r' wave in lead V1 or a pseudo S wave in leads II, III, aVF indicated anterior-type AVNRT with an accuracy of 100%. With the difference of RP' intervals in leads V1 and III >20 ms, posterior-type AVNRT could be differentiated from AVRT utilizing a posteroseptal pathway with a sensitivity of 71% (95% confidence interval [CI] 55% to 89%), a specificity of 87% (95% CI 67% to 97%) and a positive predictive value of 75% (95% CI 56% to 91%). According to the polarity of retrograde P waves in leads V1, II, III, aVF and I during AVRT, the concealed accessory pathway could be localized to one of the nine regions on the atrioventricular annuli with an accuracy of 75% (for a right midseptal pathway) to 93.8% (for a left posterior pathway). Overall, the new algorithm had an accuracy of 97.8% in discriminating AVNRT from AVRT and 88.1% in localizing a concealed accessory pathway, prospectively. Prediction was incorrect in only 15 patients (9.1%). Conclusions. The new ECG algorithm derived from the analysis of retrograde P waves during tachycardia could provide a criterion for differential diagnosis between AVNRT and AVRT and for predicting the location of concealed accessory pathways.

AB - Objectives. The purpose of this study was to use an electrocardiographic (ECG) algorithm, derived from the results of radiofrequency ablation, to discriminate atrioventricular node reentrant tachycardia (AVNRT) from atrioventricular reciprocating tachycardia (AVRT) and to localize a concealed accessory pathway, prospectively. Background. Information about ECG criteria for differentiating AVNRT from AVRT is limited and has not been confirmed by surgical or catheter ablation. Methods. Four hundred six ECGs (obtained from 406 different patients) that demonstrated narrow QRS complex (1 or pseudo S wave in inferior leads, or both, were examined, and the results were confirmed by radiofrequency catheter ablation. The initial 226 ECGs were analyzed to develop a stepwise algorithm, and the subsequent 180 ECGs were prospectively evaluated by the new algorithm. Results. The presence of a pseudo r' wave in lead V1 or a pseudo S wave in leads II, III, aVF indicated anterior-type AVNRT with an accuracy of 100%. With the difference of RP' intervals in leads V1 and III >20 ms, posterior-type AVNRT could be differentiated from AVRT utilizing a posteroseptal pathway with a sensitivity of 71% (95% confidence interval [CI] 55% to 89%), a specificity of 87% (95% CI 67% to 97%) and a positive predictive value of 75% (95% CI 56% to 91%). According to the polarity of retrograde P waves in leads V1, II, III, aVF and I during AVRT, the concealed accessory pathway could be localized to one of the nine regions on the atrioventricular annuli with an accuracy of 75% (for a right midseptal pathway) to 93.8% (for a left posterior pathway). Overall, the new algorithm had an accuracy of 97.8% in discriminating AVNRT from AVRT and 88.1% in localizing a concealed accessory pathway, prospectively. Prediction was incorrect in only 15 patients (9.1%). Conclusions. The new ECG algorithm derived from the analysis of retrograde P waves during tachycardia could provide a criterion for differential diagnosis between AVNRT and AVRT and for predicting the location of concealed accessory pathways.

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