Modified electrocardiographic algorithm for differentiating typical atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway / 中国实用内科杂志

ABSTRACT

Objective To evaluate the frequently used electrocardiographic criteria and propose a modified algorithm for differentiating typical atrioventricular node reentrant tachycardia(AVNRT)from atrioventricular reciprocating tachycardia(AVRT).Methods Twelve-lead electrocardiograms(ECGs)during sinus rhythm and atrioventricular node reentrant tachycardia(AVNRT)or atrioventricular reciprocating tachycardia(AVRT)with a narrow QRS complex were obtained from 154 patients who had received successful radiofrequency catheter ablation from Jan.2003 to Nov.2005.The ECGs of initial 104 patients were analyzed by 3 observers without knowledge of the electrophysiological diagnosis.According to these initial results,we proposed a modified stepwise ECG algorithm which used pseudo r′/S/Q waves,RP interval,and ST-segment elevation in lead aVR during tachycardia.Two observers assessed the algorithm in additional 50 patients.Results The algorithm was able to increase the overall accuracy from 77% and 79% with original algorithm to 84% and 87% with the modified algorithm,respectively.The inter-observer concordance was 85%.The intra-observer concordance was 89% in both investigators.Conclusion The modified algorithm can improve the accuracy of differential diagnosis between typical AVNRT and AVRT via concealed accessory pathway.