Jaeggi Edgar T, Gilljam Thomas, Bauersfeld Urs, Chiu Christine, Gow Robert
Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Am J Cardiol. 2003 May 1;91(9):1084-9. doi: 10.1016/s0002-9149(03)00153-x.
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.
心电图（ECG）在室上性心动过速（SVT）患儿中的价值尚不清楚。典型房室结折返性心动过速（AVNRT）与隐匿性旁路传导介导的房室折返性心动过速（AVRT）的无创鉴别在临床上具有重要意义，因为它有助于提供咨询建议，并可能促进消融手术。在成功进行射频导管消融术前，从患儿处获取了148份显示窄QRS波群SVT的心电图。最初的102份心电图由3名不知情的观察者进行分析，以评估各种心电图表现的效用。在1至3通道动态心电图/事件记录器记录上（n = 32），未发现能区分SVT机制的心电图标准；其解读主要（55%）导致SVT诊断错误。在12导联心电图上（n = 70），76%的患者两种心律失常被准确诊断；发现5种表现可作为心动过速机制的鉴别指标。AVRT的预测指标为74%的病例可见P波（敏感性92%；特异性64%）、91%的病例RP间期≥100 ms（敏感性84%；特异性91%）以及73%的病例ST段压低≥2 mm（敏感性52%；特异性82%）。心动过速期间V(1)导联的假性r'波和下壁导联的假性S波在100%的病例中预测为AVNRT（敏感性分别为5%和20%；特异性均为100%）。基于这些结果，我们开发了一种针对心动过速期间假性r'/S波、RP间期和ST段压低的新型诊断性12导联心电图算法。两名观察者在另外46例（21例AVNRT；25例AVRT）病例中测试了该算法；他们分别在91%和87%的病例中正确诊断了SVT机制。因此，逐步使用具有诊断意义的12导联心电图参数有助于更准确地区分折返性SVT的机制。
