Braunschweig Frieder, Christel Petra, Jensen-Urstad Mats, Andersson Mats, Schwieler Jonas, Tapanainen Jari, Bastani Hamid, Gadler Fredrik, Linde Cecilia, Schöls Wolfgang, Bergfeldt Lennart
Electrophysiology & Arrhythmia Service, Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Ann Noninvasive Electrocardiol. 2011 Oct;16(4):327-35. doi: 10.1111/j.1542-474X.2011.00459.x.
To establish the diagnostic accuracy of the transesophageal ventriculo-atrial (VA) interval in patients with paroxysmal supraventricular tachycardia (PSVT) and normal baseline electrocardiogram (ECG).
The transesophageal VA interval during tachycardia was recorded in 318 patients (age 45 ± 17 years, 58% female) with PSVT and a normal surface ECG between attacks. Subsequently, all patients underwent an ablation procedure establishing the correct tachycardia diagnosis.
AV nodal reentrant tachycardia (AVNRT), AV reentrant tachycardia through a concealed accessory pathway (AVRT), and ectopic atrial tachycardia (EAT) were found in 213, 95, and 10 cases, respectively. Receiver operating characteristic curve analysis identified an optimal cutoff for a binary categorization of AVNRT versus AVRT/EAT at ≤80 ms (area under the curve 0.891). Owing to a biphasic distribution, AVNRT was very likely at VA intervals ≤90 ms with a sensitivity, specificity, and positive predictive value (PPV) of 87%, 91%, and 95%. In the range 91-160 ms the corresponding values for AVRT were 88%, 95%, and 88% (90%, 99%, and 98% in male patients). In the small group with VA intervals >160 ms (n = 29), the diagnosis was less clear (PPV of 67% for AVNRT).
In patients with sudden onset regular tachycardia and a normal ECG during sinus rhythm, a transesophageal VA interval of ≤80 ms has the highest diagnostic accuracy to diagnose AVNRT versus AVRT/EAT. Overall, the biphasic distribution of VA intervals suggests considering AVNRT at 90 ms and below and AVRT between 91 and 160 ms (in particular in male patients) while the diagnosis is vague at VA intervals above 160 ms.
确定经食管心室 - 心房（VA）间期对阵发性室上性心动过速（PSVT）且基线心电图（ECG）正常患者的诊断准确性。
记录318例PSVT患者（年龄45±17岁，58%为女性）心动过速发作时的经食管VA间期，这些患者发作间期体表ECG正常。随后，所有患者均接受了能确立正确心动过速诊断的消融手术。
分别在213例、95例和10例患者中发现房室结折返性心动过速（AVNRT）、经隐匿性旁路的房室折返性心动过速（AVRT）和房性异位性心动过速（EAT）。受试者工作特征曲线分析确定，对于AVNRT与AVRT/EAT的二元分类，最佳截断值为≤80 ms（曲线下面积0.891）。由于呈双相分布，VA间期≤90 ms时AVNRT可能性很大，其敏感性、特异性和阳性预测值（PPV）分别为87%、91%和95%。在91 - 160 ms范围内，AVRT的相应值分别为88%、95%和88%（男性患者为90%、99%和98%）。在VA间期>160 ms的小群体（n = 29）中，诊断不太明确（AVNRT的PPV为67%）。
对于窦性心律时突发规则性心动过速且ECG正常的患者，经食管VA间期≤80 ms对诊断AVNRT与AVRT/EAT具有最高的诊断准确性。总体而言，VA间期的双相分布提示，VA间期≤90 ms时考虑AVNRT，91至160 ms时考虑AVRT（尤其是男性患者），而VA间期>160 ms时诊断不明确。
