1
|
Mercik J, Radziejewska J, Pach K, Zawadzki G, Zyśko D, Gajek J. ST-segment depression in atrioventricular nodal reentrant tachycardia: Important finding or just an artifact? Medicine (Baltimore) 2022; 101:e31806. [PMID: 36626431 PMCID: PMC9750532 DOI: 10.1097/md.0000000000031806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The ST segment is component of the QRS-T complex located between the QRS and the T wave. ST segment changes during tachycardia with narrow QRS mainly takes the form of ST segment depression. This phenomenon is often observed in young healthy people for whom an ischemic background is unlikely. MATERIALS AND METHODS The study included 104 patients (71 women and 33 men) with paroxysmal narrow QRS complex tachycardia. In all patients electrophysiological study was performed and the diagnosis of atrioventricular nodal reentrant tachycardia was established. The arrhythmogenic substrate was then eliminated successfully by subsequent ablation using radiofrequency energy which confirmed the diagnosis, all patients had measured QRS components - QR, RS and RJ during the tachycardia and during the sinusrhythm. All of the measurements were done in lead V5. RESULTS The difference RJ-QR during tachycardia and sinus rhythm correlated negatively with tachycardia cycle length (R = 0.356, P = .001), first slowly, then rapidly reaching the cycle value of about 300 ms, then it decreases, stabilizing at the cycle level of about 270. By separating the RJ-QR in tachycardia and in the sinus rhythm from the tachycardia cycle, we can see that the correlation described in this point is largely due to the correlation between the heart rate and RJ-QR length in tachycardia. CONCLUSIONS In patients with atrioventricular nodal reentrant tachycardia, there is a significant ST-segment depression during tachycardia episodes and the degree of this change is related to tachycardia cycle length. The most probable explanation of the ST-segment depression is the overlap of the QRS complex on the preceded T wave. This phenomenon is also influenced by some intrinsic properties of the individual electrocardiogram. It is possible to rule out ischemic origin of the presented ST segment change.
Collapse
Affiliation(s)
- Jakub Mercik
- Department of Emergency Medicine, Wroclaw Medical University, Poland
| | | | - Katarzyna Pach
- Students’ Scientific Association, Department of Emergency Medical Service, Wroclaw Medical University, Poland
| | - Grzegorz Zawadzki
- Students’ Scientific Association, Department of Emergency Medical Service, Wroclaw Medical University, Poland
| | - Dorota Zyśko
- Department of Emergency Medicine, Wroclaw Medical University, Poland
| | - Jacek Gajek
- Department of Emergency Medical Service, Wroclaw Medical University, Poland
| |
Collapse
|
2
|
Shaabani S, Sadeghian S, Hosseinsabet A. Evaluation of left ventricular longitudinal deformation in patients with and without ST segment depression during supraventricular tachycardia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:343-349. [PMID: 28369988 DOI: 10.1002/jcu.22473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/16/2017] [Accepted: 02/05/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The cumulative effect of repeated demand ischemia on left ventricular (LV) systolic function has been previously demonstrated. We evaluated the longitudinal deformation of LV myocardial fibers at systole and diastole using two-dimensional speckle-tracking echocardiography (2DSTE) in patients with and without ST-segment depression during supraventricular tachycardia. METHODS We recruited 104 consecutive patients, who were admitted to our hospital for the ablation of atrioventricular nodal reentrant tachycardia or atrioventricular reentrant tachycardia. The patients were thereafter evaluated by transthoracic echocardiography and 2DSTE, and longitudinal systolic strain and strain rate as well as early and late diastolic strain rates were measured. RESULTS We found no statistically significant differences in longitudinal systolic strain and strain rate as well as in early and late diastolic strain rates between the two study groups. CONCLUSIONS The longitudinal deformation properties of LV muscle fibers were not different between patients with and without ST-segment depression during supraventricular tachycardia. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:343-349, 2017.
Collapse
Affiliation(s)
- Sonia Shaabani
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran
| | - Saeed Sadeghian
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R. Iran
| |
Collapse
|
3
|
Filgueiras Medeiros J, Nardo-Botelho FM, Felix-Bernardes LC, Hollanda-Oliveira L, Bassolli de Oliveira-Alves L, Lúcia-Coutinho Ê, Dietrich C, Caixeta A, Almeida-de-Sousa JM, Carlos-Carvalho Â, Cirenza C, Vicenzo-de-Paola ÂA. Diagnostic Accuracy of Several Electrocardiographic Criteria for the Prediction of Atrioventricular Nodal Reentrant Tachycardia. Arch Med Res 2016; 47:394-400. [PMID: 27751374 DOI: 10.1016/j.arcmed.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
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 <0.001), age >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 <0.001). CONCLUSIONS Female, age >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.
Collapse
Affiliation(s)
| | | | | | | | | | - Ênia Lúcia-Coutinho
- Department of Cardiology, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | - Cristiano Dietrich
- Department of Cardiology, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | - Adriano Caixeta
- Department of Cardiology, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | | | | | - Cláudio Cirenza
- Department of Cardiology, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | | |
Collapse
|
4
|
Dorenkamp M, Zabel M, Sticherling C. Role of Coronary Angiography Before Radiofrequency Ablation in Patients Presenting With Paroxysmal Supraventricular Tachycardia. J Cardiovasc Pharmacol Ther 2016; 12:137-44. [PMID: 17562784 DOI: 10.1177/1074248407300775] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
During episodes of paroxysmal supraventricular tachycardia (PSVT), electrocardiograms frequently show ST-segment depressions, and patients may experience typical chest pain prompting invasive coronary angiography. We evaluated 114 patients presenting with PSVT for concomitant coronary artery disease (CAD). Patients were classified as to the type of PSVT, symptoms during PSVT, and cardiovascular risk factors. Maximum heart rate, extent of ST-segment depression, and cardiac troponin levels during PSVT were recorded. Patients were subjected to exercise testing and/or coronary angiography. During PSVT, symptoms suggestive of myocardial ischemia, including chest pain (31%), ST-segment depression (61%), and elevated troponin levels (12%), were common. Sixty-seven patients (59%) underwent coronary angiography. The overall prevalence of significant CAD was found to be low (4%) and did not correlate to symptoms during tachycardia. Routine coronary angiography cannot be recommended in patients with PSVT unless routine evaluation outside episodes of tachycardia suggests the presence of significant CAD.
Collapse
Affiliation(s)
- Marc Dorenkamp
- Department of Cardiology and Pneumology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany, and the Division of CArdiology, University Hospital, Basel, Switzerland
| | | | | |
Collapse
|
5
|
Pradhan R, Chaudhary A, Donato AA. Predictive accuracy of ST depression during rapid atrial fibrillation on the presence of obstructive coronary artery disease. Am J Emerg Med 2012; 30:1042-7. [DOI: 10.1016/j.ajem.2011.06.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 06/26/2011] [Accepted: 06/27/2011] [Indexed: 11/29/2022] Open
|
6
|
Bukkapatnam RN, Robinson M, Turnipseed S, Tancredi D, Amsterdam E, Srivatsa UN. Relationship of myocardial ischemia and injury to coronary artery disease in patients with supraventricular tachycardia. Am J Cardiol 2010; 106:374-7. [PMID: 20643248 DOI: 10.1016/j.amjcard.2010.03.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 03/09/2010] [Accepted: 03/09/2010] [Indexed: 11/16/2022]
Abstract
Increase of serum troponin I and ST-segment depression are objective markers of myocardial ischemia/injury. Abnormalities of the 2 indicators have been associated with supraventricular tachycardia (SVT) but their relevance for diagnosing acute coronary syndrome and the presence of coronary artery disease (CAD) in this setting have not been clarified. Therefore, we sought to evaluate the frequency of CAD based on increased troponin I and ST-segment depression during SVT. During a 5-year period, 104 patients were admitted with a diagnosis of SVT, 80 of whom had troponin I testing, and 70 of these patients could be assessed for ST-segment changes. Thirty-seven patients (48%) had increased troponin I (mean 1.54 +/- 2.7 ng/dl, normal <or=0.07 ng/dl) and 46 patients (57%) had ST-segment depression >or=1.0 mm. There were no significant differences in baseline characteristics and clinical presentation of patients with and without troponin I increase or ST-segment depression. There was no difference in the diagnosis of CAD by noninvasive or invasive testing in patients with and without increased troponin I. More patients with than without ST-segment depression had evidence of CAD (22% vs none, p = 0.01), but after adjusting for covariates, ST-segment depression was not a significant predictor of CAD. In conclusion, increased troponin I and ST-segment depression are not significant markers of acute coronary syndrome in patients with SVT.
Collapse
Affiliation(s)
- Radhika Nandur Bukkapatnam
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California, USA
| | | | | | | | | | | |
Collapse
|
7
|
Robinson MR, Brown RA, Srivatsa U, Amsterdam EA. Over the speed limit. Am J Med 2007; 120:851-3. [PMID: 17904453 DOI: 10.1016/j.amjmed.2007.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 06/14/2007] [Accepted: 07/23/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Melissa R Robinson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, USA
| | | | | | | |
Collapse
|
8
|
Erdinler I, Okmen E, Oguz E, Akyol A, Gurkan K, Ulufer T. Differentiation of narrow QRS complex tachycardia types using the 12-lead electrocardiogram. Ann Noninvasive Electrocardiol 2006; 7:120-6. [PMID: 12049683 PMCID: PMC7027638 DOI: 10.1111/j.1542-474x.2002.tb00152.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous studies have shown that only 80% of narrow QRS supraventricular tachycardia (SVT) types can be differentiated by standard 12-lead electrocardiographic (ECG) criteria. This study was designed to determine the value of some new ECG criteria in differentiating narrow QRS SVT. METHODS AND RESULTS 120 ECGs demonstrating paroxysmal narrow QRS complex tachycardia (QRS < or = 0.11 ms and rate > 120 beats/min) were analyzed. Forty atrioventricular reciprocating tachycardia (AVRT), 70 atrioventricular nodal reentrant tachycardia (AVNRT), and 10 atrial tachycardia defined with electrophysiologic study (EPS) consisted the study group. Eight surface ECG criteria were found to be significantly different between tachycardia types by univariate analysis. P waves separate from the QRS complex were observed more frequently in AVRT (70%) and atrial tachycardia (80%). Pseudo r' deflection in lead V(1), pseudo S wave in inferior leads, and cycle length alternans were more common in AVNRT (55, 20, and 6%, respectively). QRS alternans was also present during AVRT (28%). ST-segment depression (> or = 2 mm) or T-wave inversion, or both, were present more often in AVRT (60%) than in AVNRT (27%). During sinus rhythm, manifest preexcitation was observed more often in patients with AVRT (42%). When a P wave was present, RP/PR interval ratio > 1 was more common in atrial tachycardia (90%). By multivariate analysis, presence of a P wave separate from the QRS complex, pseudo r' deflection in lead V(1), QRS alternans, preexcitation during sinus rhythm, ST-segment depression > 2 mm or T-wave inversion, or both, were independent predictors of tachycardia type. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Izzet Erdinler
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Ertan Okmen
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Enis Oguz
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Ahmet Akyol
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Kadir Gurkan
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| | - Tanju Ulufer
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey
| |
Collapse
|
9
|
Lin YJ, Tai CT, Chiang CE, Lee KT, Yuniadi Y, Huang BH, Liu TY, Lee PC, Kuo JY, Chen SA. Mechanism of Repolarization Change During Initiation of Supraventricular Tachycardia. J Cardiovasc Electrophysiol 2004; 15:1233-7. [PMID: 15574169 DOI: 10.1046/j.1540-8167.2004.04049.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Previous literature has documented the association between narrow QRS supraventricular tachycardia (SVT) and pronounced ST-T segment change. The aim of this study was to evaluate repolarization changes during SVT initiation and demonstrate the possible mechanism. METHODS AND RESULTS Fifty-one consecutive patients (20 men and 31 women; mean age 46.1 +/- 16.4 years) with narrow QRS SVT (32 patients with AV nodal reentrant tachycardia and 19 patients with AV reentrant tachycardia) were included. We retrospectively analyzed the intracardiac recordings and ST-T segment changes on 12-lead surface ECGs during SVT initiation. Twenty-six (51%) patients developed ST segment repolarization changes during SVT initiation. Patients with shorter baseline sinus cycle length, shorter tachycardia cycle length, elevated systolic blood pressure before tachycardia induction, and greater reduction of systolic blood pressure had a higher incidence of repolarization changes. However, multivariate analysis showed that reduction of systolic blood pressure after SVT induction was the only independent predictor of repolarization changes. Furthermore, the maximal degree of ST segment depression during SVT correlated with the reduction of systolic blood pressure (r = 0.75, P < 0.001). CONCLUSION Repolarization changes during SVT initiation were caused mainly by concurrent hemodynamic change after SVT initiation with abrupt cycle length shortening.
Collapse
Affiliation(s)
- Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Ho YL, Lin LY, Lin JL, Chen MF, Chen WJ, Lee YT. Usefulness of ST-segment elevation in lead aVR during tachycardia for determining the mechanism of narrow QRS complex tachycardia. Am J Cardiol 2003; 92:1424-8. [PMID: 14675578 DOI: 10.1016/j.amjcard.2003.08.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the present study, we analyzed ST-segment elevation in lead aVR during tachycardia to differentiate the narrow QRS complex tachycardia. A total of 338 12-lead electrocardiograms during narrow QRS complex tachycardia were analyzed. Each patient underwent a complete electrophysiologic study. There were 161 episodes of atrioventricular nodal reentrant tachycardia (AVNRT), 165 episodes of atrioventricular reciprocating tachycardia (AVRT), and 12 episodes of atrial tachycardia (AT). The prevalence of aVR ST-segment elevation was 71% for AVRT, 31% for AVNRT, and 16% for AT. For ST-T changes in different leads, logistic regression analysis showed aVR ST-segment elevation was the only significant factor to differentiate the types of narrow QRS complex tachycardia (p<0.001 for AVRT and AVNRT; p=0.02 for AVRT and AT). The sensitivity, specificity, and accuracy of aVR ST-segment elevation to differentiate AVRT from AVNRT and AT were 71%, 70%, and 70%, respectively. Among 117 episodes of AVRT with aVR ST-segment elevation, there were 76 (65%) left side, 23 (20%) right side, 14 (12%) posterior septal, and 4 (3%) antero- and mid-septal accessory pathways (p=0.002). In conclusion, aVR ST-segment elevation during narrow QRS complex tachycardia favors the atrioventricular reentry through an accessory pathway as the mechanism of the tachycardia.
Collapse
Affiliation(s)
- Yi-Lwun Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
11
|
Jaeggi ET, Gilljam T, Bauersfeld U, Chiu C, Gow R. Electrocardiographic differentiation of typical atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway in children. Am J Cardiol 2003; 91:1084-9. [PMID: 12714151 DOI: 10.1016/s0002-9149(03)00153-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The value of the electrocardiogram (ECG) in children with supraventricular tachycardia (SVT) is unclear. The noninvasive differentiation of typical atrioventricular node reentrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT) mediated by concealed accessory pathway conduction is clinically important, as it helps in counseling and potentially facilitates ablation procedures. One hundred forty-eight ECGs showing narrow QRS complex SVT were obtained from children before successful radiofrequency catheter ablation. An initial 102 ECGs were analyzed by 3 blinded observers to assess the utility of various electrocardiographic findings. No electrocardiographic criteria were found to discriminate between SVT mechanisms on 1- to 3-channel Holter/event recorder tracings (n = 32); their interpretation mainly (55%) resulted in an incorrect SVT diagnosis. On 12-lead ECGs (n = 70), the 2 arrhythmias were accurately diagnosed in 76% of patients; 5 findings were found to be discriminators of tachycardia mechanism. Predictors of AVRT were visible P waves in 74% of cases (sensitivity 92%; specificity 64%), RP intervals of > or =100 ms in 91% (sensitivity 84%; specificity 91%), and ST-segment depression of > or =2 mm in 73% of cases (sensitivity 52%; specificity 82%). Pseudo r' waves in lead V(1) and pseudo S waves in the inferior leads during tachycardia predicted AVNRT in 100% of cases (sensitivity 55% and 20%, respectively; specificity 100% for both). Based on these results, we developed a new diagnostic 12-lead electrocardiographic algorithm for pseudo r'/S waves, RP duration, and ST-segment depression during tachycardia. Two observers tested the algorithm in 46 (21 AVNRT; 25 AVRT) additional cases; they correctly diagnosed the SVT mechanism in 91% and 87%, respectively. Thus, the stepwise use of diagnostically relevant 12-lead electrocardiographic parameters helps to more accurately differentiate mechanisms of reentrant SVT.
Collapse
Affiliation(s)
- Edgar T Jaeggi
- Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
12
|
Cunningham R, Mikhail MG. Management of patients with syncope and cardiac arrhythmias in an emergency department observation unit. Emerg Med Clin North Am 2001; 19:105-21, vii. [PMID: 11214393 DOI: 10.1016/s0733-8627(05)70170-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Syncope is an ideal condition for the emergency observation setting because of its difficulty in diagnosis, many causes, high liability, and variable diagnostic approaches. Hospital admissions can be averted with appropriate patient selection for a short-term observation period. Atrial fibrillation is a common presenting condition in the emergency department. With aggressive management, the appropriately selected patient can have restoration of sinus rhythm and be safely discharged home.
Collapse
Affiliation(s)
- R Cunningham
- Department of Emergency Medicine, University of Michigan Hospital, Michigan, USA
| | | |
Collapse
|
13
|
Güleç S, Ertaş F, Karaoŏuz R, Güldal M, Alpman A, Oral D. Value of ST-segment depression during paroxysmal supraventricular tachycardia in the diagnosis of coronary artery disease. Am J Cardiol 1999; 83:458-60, A10. [PMID: 10072244 DOI: 10.1016/s0002-9149(98)00888-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We evaluated 39 patients >45 years old with paroxysmal supraventricular tachycardia (SVT), 21 of whom had ST-segment depression during SVT. Treadmill exercise testing, including thallium stress scintigraphy, was performed in all patients and coronary angiography in 21 patients with ST-segment depression. Based on the presence of abnormal findings on exercise electrocardiogram and/or thallium in 7 of 21 patients (33%) with ST-segment depression, with additional corroboration by angiographic data, we conclude that myocardial ischemia and coronary artery disease is one, but not the only, mechanism involved in the genesis of ST-segment depression during paroxysmal SVT.
Collapse
Affiliation(s)
- S Güleç
- Department of Cardiology, Medical School of Ankara University, Turkey.
| | | | | | | | | | | |
Collapse
|
14
|
Xie B, Thakur RK, Shah CP, Hoon VK. Clinical differentiation of narrow QRS complex tachycardias. Emerg Med Clin North Am 1998; 16:295-330. [PMID: 9621846 DOI: 10.1016/s0733-8627(05)70005-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Supraventricular tachycardias generally present with narrow QRS complexes and are quite commonly seen in the emergency department. Regular narrow QRS complex tachycardias occur in all age groups and may be associated with minimal symptoms, such as palpitations, or, present with hemodynamic compromise resulting in syncope. While history and physical examination are indispensable, they usually do not lead to a definitive diagnosis. The diagnosis is made by careful analysis of the 12-lead ECG. Therapy is based on hemodynamic assessment and understanding of the tachycardia mechanism.
Collapse
Affiliation(s)
- B Xie
- Department of Internal Medicine, Michigan State University, East Lansing, USA
| | | | | | | |
Collapse
|
15
|
Riva SI, Della Bella P, Fassini G, Carbucicchio C, Tondo C. Value of analysis of ST segment changes during tachycardia in determining type of narrow QRS complex tachycardia. J Am Coll Cardiol 1996; 27:1480-5. [PMID: 8626962 DOI: 10.1016/0735-1097(96)00013-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Repolarization changes during narrow QRS complex tachycardia were analyzed to differentiate the tachycardia mechanism and to guide the preliminary location of the accessory pathway. BACKGROUND Noninvasive determination of the mechanism of tachycardia is becoming increasingly important in view of the role of catheter ablation techniques for the cure of supraventricular tachycardia. METHODS We analyzed 159 12-lead electrocardiograms during narrow QRS complex tachycardia to evaluate 1) the tachycardia cycle; and 2) ST segment depression or T wave inversion, or both. Each patient underwent a complete electrophysiologic evaluation. RESULTS There were 13 atrial tachycardias, 57 atrioventricular (AV) node reentrant tachycardias and 89 AV reciprocating tachycardias. The mean RR cycle did not differ among types of tachycardia. ST segment depression >2 mm or T wave inversion, or both, was present more often in AV reciprocating tachycardia (57%) than in AV node tachycardia (25%). The magnitude of ST segment depression was greater in AV reciprocating tachycardia than in AV node tachycardia (mean +/- SD 1.3 +/- 1.6 vs. 0.7 +/- 0.8 mm, p < 0.005). In AV reciprocating tachycardia distinct patterns of repolarization changes and P wave configuration were associated with different sites of the accessory pathway. CONCLUSIONS The presence of ST segment depression >2 mm or T wave inversion, or both, during narrow QRS complex tachycardia suggests that AV reentry using an accessory pathway is the mechanism of the tachycardia. The phenomenon may be the consequence of a distinct pattern of retrograde atrial activation. Analysis of repolarization changes can guide preliminary localization of the accessory pathway even in the absence of ventricular preexcitation.
Collapse
Affiliation(s)
- S I Riva
- Instituto di Cardiologia, Universitá degli Studi, Milan, Italy
| | | | | | | | | |
Collapse
|
16
|
|