Usefulness of retrograde P waves for differentiating supraventricular tachycardia.
- Author:
Jong Min SONG
1
;
Yun Shik CHOI
;
In Ho CHAE
;
Hyo Soo KIM
;
Dae Won SOHN
;
Byung Hee OH
;
Myoung Mook LEE
;
Young Bae PARK
;
Young Woo LEE
Author Information
1. Department of Internal Medicine, Seoul National University College of Medicine, Korea.
- Publication Type:Original Article
- Keywords:
Algorithms;
Electrocardiography;
Tachycardia;
Supraventricular
- MeSH:
Electrocardiography;
Humans;
Tachycardia;
Tachycardia, Atrioventricular Nodal Reentry;
Tachycardia, Supraventricular*
- From:Korean Journal of Medicine
2000;59(3):268-276
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Retrograde P wave can be found not only in atrioventricular reentrant tachycardia (AVRT) but also in atrioventricular nodal reentrant tachycardia (AVNRT), especially of posterior-type. This study evaluated the usefulness of retrograde P wave for differentiating AVNRT from concealed AVRT and for localization of accessory pathway(AP). METHODS: Twelve lead ECGs were analyzed in patients with AVNRT (n=41) and concealed AVRT (n=53) who have taken successful ablation. Presence of pseudo r' in V1, pseudo S in II, III, aVF, and configuration and polarity of presumed retrograde P waves were evaluated. RP was obtained by subtracting RP interval in III from that in V1. RESULTS: In anterior-type AVNRTs (n=38), there were no retrograde P wave in 53% and the pseudo r' and/or S in 47%. Retrograde P waves in V1 were positive in 67% (2/3 cases) of posterior-type AVNRTs and 97.4% (37/38 cases) of AVRTs with left free wall AP, but negative in 83.3% (5/6 cases) of AVRTs with right free wall AP. Retrograde P waves in II, III, aVF were negative in all of posterior-type AVNRTs, all with left and right posteroseptal AP, right posterior AP, and 90% (9/10 cases) with left posterior AP. All with left anterior and right anteroseptal AP showed positive P wave in III. RP of posterior-type AVNRT was significantly larger than those with left posteroseptal or left posterior AP (p<0.01). Sensitivity of newly developed stepwise algorithm was 50-100%. CONCLUSION: Retrograde P wave during tachycardia on standard ECG is very useful for differentiation of AVNRT from concealed AVRT and also for localization of APs.
