Blommaert Dominique, Dormal Fabien, Deceuninck Olivier, Xhaet Olivier, Ballant Elisabeth, De Roy Luc
Catholic University of Louvain, CHU UCL Namur, Cardiology Service, Yvoir, Belgium.
Ann Noninvasive Electrocardiol. 2018 Jan;23(1). doi: 10.1111/anec.12471. Epub 2017 Jun 8.
Supraventricular tachycardias (SVT) are a common arrhythmia therefore an accurate diagnosis is of clinical importance. Although an ECG performed during tachycardia greatly aids diagnosis, patient history and predisposing factors also improve diagnostic accuracy.
This prospective study included 100 consecutive patients undergoing electrophysiological study for SVT with the aim to reassess their clinical characteristics and describe frequent predisposing factors, such as the "sign of lace-tying" that to our knowledge has not previously been reported. Each patient completed an extensive questionnaire (70 questions) during their hospital stay.
Our series comprised: 67% of patients with atrioventricular nodal reentrant tachycardia (AVNRT); 24% with an accessory pathway; and 9% presented atrial tachycardia. Half of the population were male and 29% of the cohort presented hypertension. Syncope during tachycardia appeared in 15% of patients, dizziness in 52% and thoracic pain in 59%. We encountered a predisposing risk factor for SVT in 53% of cases; with 32% exhibiting an anteflexion of the trunk termed the "sign of lace-tying." Data also showed that younger patients tended to present AVRT and regular pounding in the neck appeared only in patients with AVNRT.
Overall, our study has highlighted the importance of considering clinical signs and patient characteristics both before and during SVT for the precise diagnosis of paroxysmal SVT. Furthermore, 32% of patients presented the "sign of lace-tying" or body position change before SVT, implying a diagnosis of SVT.
室上性心动过速（SVT）是一种常见的心律失常，因此准确诊断具有临床重要性。虽然心动过速发作时进行的心电图对诊断有很大帮助，但患者病史和诱发因素也有助于提高诊断准确性。
这项前瞻性研究纳入了100例连续接受室上性心动过速电生理检查的患者，目的是重新评估他们的临床特征并描述常见的诱发因素，如据我们所知此前尚未报道的“系鞋带征”。每位患者在住院期间完成了一份详细的问卷（70个问题）。
我们的研究系列包括：67%的房室结折返性心动过速（AVNRT）患者；24%有旁路；9%为房性心动过速。一半患者为男性，29%的队列患有高血压。15%的患者在心动过速时出现晕厥，52%出现头晕，59%出现胸痛。我们在53%的病例中发现了室上性心动过速的诱发危险因素；32%表现为躯干前屈，即“系鞋带征”。数据还显示，年轻患者倾向于出现房室折返性心动过速（AVRT），而颈部规律性搏动仅出现在房室结折返性心动过速（AVNRT）患者中。
总体而言，我们的研究强调了在室上性心动过速发作前和发作期间考虑临床体征和患者特征对于阵发性室上性心动过速精确诊断的重要性。此外，32%的患者在室上性心动过速发作前出现“系鞋带征”或体位改变，提示室上性心动过速的诊断。
