Regular paperElectrocardiographic differentiation of typical atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway in children
Section snippets
Electrocardiograph selection
Electrocardiographic recordings of otherwise healthy children with paroxysmal SVT (n = 148; mean age ± SD 10.6 ± 3.9 years) were evaluated. The arrhythmias occurred either spontaneously or were induced during an invasive electrophysiologic study. The 12-lead tracings were recorded at a paper speed of 25 or 50 mm/s with a gain setting of 10 mm/mV. The 2-channel Holter and 1- or 3-channel event were recorded at a paper speed of 25 mm/s. In all cases, the ECG was also recorded during sinus rhythm.
Part 1
Of the initial 102 ECGs, 54 (53%) were AVNRT and 48 (47%) were AVRT (Table 1). The 2 arrhythmias were documented at comparable patient ages (10.8 ± 3.1 vs 9.4 ± 4.8 years).
Inter- and intraobserver concordance
Table 2 illustrates the degree of agreement in interpreting electrocardiographic variables. There was only modest interobserver concordance on the suspected SVT mechanism after analysis of Holter/event electrocardiographic recordings and 12-lead ECGs.
Holter/event recorder electrocardiographic analyses (table 3)
The investigators were unable to correctly identify SVT mechanisms based on
Discussion
The present study demonstrates the utility of 12-lead electrocardiographic parameters for the differentiation of orthodromic AVRT from typical AVNRT in the pediatric population. Some findings have previously been reported to be of differential diagnostic value in adults.2, 3, 4, 5, 6, 7, 8, 9, 10 For example, ventricular preexcitation during sinus rhythm strongly suggests the diagnosis of orthodromic AVRT in any narrow QRS complex tachycardia.6 For the purpose of this study, we focused on the
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