Differential Diagnosis Using 12-lead Electrocardiogram and Significance of ST-T in Paroxysmal Supraventricular Tachycardia / 대한내과학회지

ABSTRACT

OBJECTIVES: Accurate differential diagnosis of paroxysmal supraventricular tachycardia (PSVT) has become more important after introduction of curative catheter ablation technique into clinical practice. It has been reported that ST-T changes during supraventricular tachycardia are frequent, but its association is different according to the type of PSVT and the location of the AV bypass tracts. Therefore, this study was performed to evaluate the significance of ST-T changes in addition to classic ECG parameters in differentiating AV nodal reentrant tachycardia (AVNRT) and AV reentrant tachycardia (AVRT), and predicting the location of the AV bypass tracts. METHODS: One hundred thirty patients presenting with narrow-QRS complex ( or =1 mm was observed in 27.8% of AVNRT and 79.9% of AVRT (p or =2 mm was observed in 76.9% of the left posterior pathways, 28.1% of the left anterolateral pathways, 66.7% of the right posterior pathways, and 1.1% of the right anterior pathways. Sensitivity, specificity, and positive predictive value in differentiating AVRT from AVNRT with visible p wave were 72%, 91%, and 92%, respectively 78%, 72%, and 80%, respectively with ST segment depression > or =1 mm, and 30%, 93%, and 85%, respectively with T wave inversion. In differentiating AVNRT from AVRT, Sensitivity, Specificity, and positive predictive value of pseudo r' wave and pseudo s wave were 59%, 92%, 84%, respectively and 33%, 99%, 94%, respectively. Sensitivity, specificity, and positive predictive value in distinguishing posterior location from anterior location of the pathways were 74%, 76%, and 72%, respectively with ST segment depression (> or =2 mm) and 46%, 83%, and 70%, respectively with T wave inversion. CONCULSIONS ST Segment depression during PSVT can be used complementally to the classic ECG parameters in the differential diagnosis of PSVT and predicting the location of the AV bypass tracts.