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COŞKUN A, HINCAL ŞÖ, EREN ŞH. The Importance of Osmolarity in the Prognosis Prediction of ST-elevation and Depression in aVR Derivation of Patients with Acute Coronary Syndrome. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2021.6212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 522] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Demirtaş AO, Icen YK, Kaypaklı O, Koca H, Ünal İ, Köseoğlu Z, Sahin DY, Koc M. A new criterion to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia: Combined AVR criterion. J Electrocardiol 2018; 51:1045-1051. [PMID: 30497728 DOI: 10.1016/j.jelectrocard.2018.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/04/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
Abstract
AIM A combined aVR criterion is described as the presence of a pseudo r' wave in aVR during tachycardia in patients without r' wave in aVR in sinus rhythm and/or a ≥50% increase in r' wave amplitude compared to sinus rhythm in patients with r' wave in the basal aVR lead. We aimed to investigate the use of combined aVR criterion in differential diagnosis of atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). METHODS In this prospective study, 480 patients with inducible narrow QRS supraventricular tachycardia (SVT) were included. Twelve-lead electrocardiogram (ECG) was conducted during tachycardia and sinus rhythm. The patients were divided into two groups according to the arrhythmia mechanism that determined via EPS, AVNRT, and AVRT. Criteria of narrow QRS complex tachycardia were compared between the two groups. RESULTS AVNRT was present in 370 (77%) patients and AVRT in 110 (23%) patients. Combined aVR criterion was found to be more frequent in patients with AVNRT (84.1% and 9.1%, p < 0.001). In logistic regression analysis, combined aVR criterion and classical ECG criterion were found to be the most important predictors of AVNRT (p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of the combined aVR criterion for AVNRT were 84.1%, 90.9%, 96.9%, and 62.9%, respectively. CONCLUSION In the differential diagnosis of patients with SVT, the combined aVR criterion identifies the presence of AVNRT with an independent and acceptable diagnostic value. In addition to classical ECG criteria for AVNRT, it is necessary to evaluate the combined aVR criterion in daily practice.
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Affiliation(s)
- Abdullah Orhan Demirtaş
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Yahya Kemal Icen
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Onur Kaypaklı
- Department of Cardiology, Mustafa Kemal University - Faculty of Medicine, Hatay, Turkey
| | - Hasan Koca
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - İlker Ünal
- Department of Biostatistics, Cukurova University - Faculty of Medicine, Adana, Turkey
| | - Zikret Köseoğlu
- Emergency Medicine, Department of Emergency Medicine, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Durmus Yıldıray Sahin
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Mevlut Koc
- Department of Cardiology, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey.
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
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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.
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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
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Nakatani Y, Mizumaki K, Sakamoto T, Kataoka N, Nishida K, Yamaguchi Y, Tsujino Y, Inoue H. Differentiation of Slow-Slow Form of AVNRT from AVRT through a Posteroseptal Accessory Pathway by Retrograde P-Wave Amplitude. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:241-9. [PMID: 26643980 DOI: 10.1111/pace.12794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/11/2015] [Accepted: 11/20/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to clarify whether retrograde P-wave amplitude during tachycardia can be used to differentiate slow-slow form of atrioventricular nodal reentrant tachycardia (S/S-AVNRT) from atrioventricular reentrant tachycardia through a posteroseptal accessory pathway (PS-AVRT). METHODS Sixteen patients with S/S-AVNRT and 14 patients with PS-AVRT constituted the study group. Electrocardiographic and electrophysiological parameters were compared between both the groups. HA(CS-His), which indicates the location of the earliest atrial activation site during tachycardia, was calculated as the difference of the shortest HA interval in the His bundle region and the coronary sinus region. RESULTS Negative deflection of the retrograde P wave during tachycardia was significantly greater in S/S-AVNRT than in PS-AVRT in the inferior leads (lead aVF, -0.22 ± 0.04 mV vs -0.10 ± 0.07 mV; P < 0.001). Among the electrocardiographic parameters, retrograde P-wave amplitude in lead aVF had the highest diagnostic accuracy (area under the curve 0.975, sensitivity 93%, and specificity 88% for a cutoff value of -0.16 mV). HA(CS-His) was negatively greater in S/S-AVNRT than in PS-AVRT (-24 ± 13 ms vs -3 ± 18 ms; P = 0.001), and was significantly correlated with the retrograde P-wave amplitude in lead aVF (P = 0.004). CONCLUSION Deeper negative deflection of the retrograde P wave in the inferior lead can help differentiate S/S-AVNRT from PS-AVRT.
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Affiliation(s)
- Yosuke Nakatani
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichi Mizumaki
- Clinical Research and Ethics Center, University of Toyama, Toyama, Japan
| | - Tamotsu Sakamoto
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Kunihiro Nishida
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Yoshiaki Yamaguchi
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Yasushi Tsujino
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hiroshi Inoue
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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Deutsch K, Stec S, Kukla P, Morka A, Jastrzebski M, Baszko A, Pitak M, Sledz J, Fijorek K, Mazij M, Ludwik B, Gubaro M, Szydlowski L. Validation of Standard and New Criteria for the Differential Diagnosis of Narrow QRS Tachycardia in Children and Adolescents. Medicine (Baltimore) 2015; 94:e2310. [PMID: 26705217 PMCID: PMC4697983 DOI: 10.1097/md.0000000000002310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To establish an appropriate treatment strategy and determine if ablation is indicated for patients with narrow QRS complex supraventricular tachycardia (SVT), analysis of a standard 12-lead electrocardiogram (ECG) is required, which can differentiate between the 2 most common mechanisms underlying SVT: atrioventricular nodal reentry tachycardia (AVNRT) and orthodromic atrioventricular reentry tachycardia (OAVRT). Recently, new, highly accurate electrocardiographic criteria for the differential diagnosis of SVT in adults were proposed; however, those criteria have not yet been validated in a pediatric population.All ECGs were recorded during invasive electrophysiology study of pediatric patients (n = 212; age: 13.2 ± 3.5, range: 1-18; girls: 48%). We assessed the diagnostic value of the 2 new and 7 standard criteria for differentiating AVNRT from OAVRT in a pediatric population.Two of the standard criteria were found significantly more often in ECGs from the OAVRT group than from the AVNRT group (retrograde P waves [63% vs 11%, P < 0.001] and ST-segment depression in the II, III, aVF, V1-V6 leads [42% vs 27%; P < 0.05]), whereas 1 standard criterion was found significantly more often in ECGs from the AVNRT group than from the OAVRT group (pseudo r' wave in V1 lead [39% vs 10%, P < 0.001]). The remaining 6 criteria did not reach statistical significance for differentiating SVT, and the accuracy of prediction did not exceed 70%. Based on these results, a multivariable decision rule to evaluate differential diagnosis of SVT was performed.These results indicate that both the standard and new electrocardiographic criteria for discriminating between AVNRT and OAVRT have lower diagnostic values in children and adolescents than in adults. A decision model based on 5 simple clinical and ECG parameters may predict a final diagnosis with better accuracy.
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Affiliation(s)
- Karol Deutsch
- From the ELMedica EP-Network, Kielce (KD, SS, JS); Medical University of Warsaw, Warsaw (KD, MG); Department of Electroradiology, University of Rzeszow, Rzeszow (SS); PCISN, G.V.M. Carint, Sanok (SS); Department of Internal Disease and Cardiology, Specialistic Hospital, Gorlice (PK); Department of Cardiosurgery et Cardiosurgical Intensive Care Polish-American Children's Hospital, Jagiellonian University Medical College in Krakow, Krakow (AM); First Department of Cardiology and Interventional Electrocardiology, University Hospital, Cracow (MJ); Department of Paediatric Cardiology, Poznan University of Medical Sciences, Poznan (AB); Department of Pediatrics, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow (MP); Carint-Medica, Cracow (JS); Department of Statistics, Cracow University of Economics, Kracow (KF); Regional Specialist Hospital, Research and Development Centre, Wroclaw (MM, BL); and Department of Pediatric Cardiology, Medical University of Silesia in Katowice, Poland (LS)
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Katritsis DG, Josephson ME. Differential diagnosis of regular, narrow-QRS tachycardias. Heart Rhythm 2015; 12:1667-76. [DOI: 10.1016/j.hrthm.2015.03.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Indexed: 10/23/2022]
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Almendral J, Pombo M, Martínez-Alday J, González-Rebollo JM, Rodríguez-Font E, Martínez-Ferrer J, Castellanos E, García-Fernández FJ, Ruiz-Mateas F. Update on arrhythmias and cardiac pacing 2013. ACTA ACUST UNITED AC 2014; 67:294-304. [PMID: 24774592 DOI: 10.1016/j.rec.2013.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/12/2013] [Indexed: 11/19/2022]
Abstract
This report discusses a selection of the most relevant articles on cardiac arrhythmias and pacing published in 2013. The first section discusses arrhythmias, classified as regular paroxysmal supraventricular tachyarrhythmias, atrial fibrillation, and ventricular arrhythmias, together with their treatment by means of an implantable cardioverter defibrillator. The next section reviews cardiac pacing, subdivided into resynchronization therapy, remote monitoring of implantable devices, and pacemakers. The final section discusses syncope.
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Affiliation(s)
- Jesús Almendral
- Unidad de Arritmias, Centro Integral de Enfermedades Cardiovasculares, Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain.
| | - Marta Pombo
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Jesús Martínez-Alday
- Unidad de Arritmias, Servicio de Cardiología, Hospital de Basurto, Bilbao, Vizcaya, Spain
| | - José M González-Rebollo
- Unidad de Arritmias, Servicio de Cardiología, Complejo Asistencial Universitario de León, León, Spain
| | - Enrique Rodríguez-Font
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Martínez-Ferrer
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de Araba, Vitoria, Álava, Spain
| | - Eduardo Castellanos
- Unidad de Arritmias, Centro Integral de Enfermedades Cardiovasculares, Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | | | - Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Área de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
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Almendral J, Pombo M, Martínez-Alday J, González-Rebollo JM, Rodríguez-Font E, Martínez-Ferrer J, Castellanos E, García-Fernández FJ, Ruiz-Mateas F. Novedades en arritmias y estimulación cardiaca en 2013. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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