Usefulness of ST-segment elevation in lead aVR during tachycardia for determining the mechanism of narrow QRS complex tachycardia

A modified electrocardiographic algorithm for differentiating typical atrioventricular node re-entrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway

“…Several studies have evaluated the value of 12‐lead electrocardiographic recordings for differentiating AVNRT and AVRT by concealed accessory pathway (2–11). The frequently used criteria were able to accurately diagnose approximately 70–80% of cases of AVRT and AVNRT.…”

“…In our study, there were no cases with a history of coronary artery disease and pulmonary embolism; thus, the aVR ST‐segment elevation during tachycardia could not be ascribed to myocardial ischaemia or right ventricular overload caused by pulmonary embolism. Recently, Ho et al (2) found that aVR ST‐segment elevation during narrow QRS complex tachycardia was more common in AVRT than in AVNRT. They suggested that the change of the ST segment in lead aVR is not due to the alternation of the ventricle repolarisation but rather to the distortion of the ST segment by the retrograde P wave.…”

“…Although the electrophysiological study is essential and can reliably determine the mechanism of the tachycardia in the era of catheter ablation, non‐invasive prediction of the mechanism of tachycardia by standard 12‐lead electrocardiogram (ECG) may be helpful in counselling and planning the ablation technique in advance. So far, several criteria and stepwise algorithms have been reported to distinguish these tachycardias (2–11). Therefore, we performed this retrospective study (i) to evaluate the frequently used criteria and to search for other possible criteria; (ii) to develop a modified stepwise algorithm by integrating the ST‐segment shift in lead aVR with often used criteria; (iii) to determine the diagnostic accuracy of the modified algorithm and to compare it with other stepwise algorithms.…”

Heart rate is a predictor of success in the treatment of adults with symptomatic paroxysmal supraventricular tachycardia

“…Also, the protocol of the study was designed taking into account that: (1) PSVT subtype identification by surface ECG is often difficult to perform, particularly when the tachycardia presents high frequencies, (2) electrophysiological tests are not routinely performed in clinical practice, (3) although various electrocardiographic criteria have been proposed in the attempt to distinguish different types of PSVT, [100][101][102] about 20% of PSVT may be incorrectly classified on the basis of the surface ECG. 7 The possibility that some cases of regular atrial flutter with conduction ratio 2:1 have been classified as PSVT or vice versa should also be taken into account.…”

10.5937/mckg48-4068 = Diagnostic and prognostic utility of aVR lead in electrocardiogram

“…U kardiološkoj praksi analizi ovog odvoda ne poklanja se dovoljna pažnja. Promene u smislu recipročne depresije ST segmenta i elevacije PR segmenta u odnosu na ostale odvode opisane su u u akutnom perikarditisu (8,9), dok je morfologija P talasa opisana kao značajna u razlikovanju atrijalnih tahikardija (10,11). Pažljivija interpretacija aVR odvoda može da pomogne u dijagnostici akutne okluzije glavnog stabla leve koronarne arterije (LMCA) ili okluzije proksimalnog segmenta prednje silazne arterije (RIA), i na taj način utiče na vreme i vrstu terapije, ali i da ukaže na prognozu kod bolesnika sa akutnim infarktom miokarda (12,13).…”