No abstract available.
Diagnosis, Differential* ; Tachycardia* ; Tachycardia, Supraventricular*

62 patients with paroxysmal supraventricular tachycardia were treated at the 103 Hospital and the 175 Hospital between 2000-2002, who were diagnosed due to clinical and ECG before and after treatment. The effects obtened by methods: pressing eyeball (15.3%); direct current cardioversion (100%); verapamil (92.9%); other drugs (83.3-85.7%); rapid atrial pacing (66.7%).
Therapeutics ; Tachycardia, Supraventricular ; Diagnosis

Electrocardiography ; Humans ; Tachycardia, Sinus/diagnosis*

BACKGROUND AND OBJECTIVES: The differential diagnosis of a regular tachycardia, with a wide QRS complex(> or =20 msec) n the 12-lead electrocardiogram(CG), remains an important challenge. Despite the information available on electrocardiography in patients with ventricular tachycardia(T) nd supraventricular ventricular tachycardia, with aberrant conduction or pre-existed bundle branch block(ide-QRS SVT); the data from Korean is limited. The purpose of this study was to report on the differential diagnostic criteria.SUBJECTS AND METHODS: The clinical and electrocardiographic characteristics of 150 patients(5.8%) ith VT, and 78(4.2%) ith wide-QRS SVT, were evaluated. RESULTS: n atrioventricular(V) issociation was found in 44.7%(7/150) f the VTs, which is very useful in differential diagnosis. In the RBBB patterns, a monophasic R, or a biphasic, wave(R, RS), in the V1 lead, were present in 49.0 and 40.6% of VTs, respectively, and an R/S ratio of less than 1, in the V6 lead, was present in 89.6% of VTs. In the LBBB patterns, the duration of the R wave(gt; or =0 msec), the interval from the Q wave to the nadir of the S wave(> or =0 msec) nd the notching of the S wave, in the V1 lead, were present in 61.1, 87.0 and 31.3% of VTs, respectively. When an algorithm, using the AV dissociation and morphological criteria for a VT in the V1 and V6 leads, was tested for differentiation, the sensitivity and specificity were 96.7 and 93.6%, respectively. CONCLUSION: A more accurate, correct, diagnosis of wide-QRS tachycardia can be made by using a stepwise approaching method consisting of AV dissociation and morphological criteria for VT in the V1 and V6 leads.
Diagnosis ; Diagnosis, Differential* ; Electrocardiography* ; Humans ; Sensitivity and Specificity ; Tachycardia* ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

Humans ; Tachycardia/diagnosis* ; Diagnosis, Differential ; Electrocardiography

PURPOSE: In dealing with wide-complex tachycardia (WCT), it is important to distinguish between ventricular tachycardia (VT), supraventricular tachycardia with aberrancy (SVTAC), and preexcited tachycardia by using an accessory pathway. The aim of this study was to investigate and compare the Brugada and the Bayesian algorithms and to analyze the parameters. METHODS: Between January 1999 and December 2003, the Brugada and the Bayesian approaches were retrospectively analyzed in 103 WCTs confirmed by electrophysiologic studies. RESULTS: Seven-eight (75) VTs and 25 SVTs were found. The sensitivity and the specificity for VT achieved by using the Brugada approach were 91.0 and 68.0%, respectively, whereas those achieved by using the Bayesian approach were 84.6 and 60.0%. In the Brugada approach, the most important step was the fourth step (odds ratio: 4.33; 95% CI: 1.75-12.14). In the Bayesian approach, triphasic rsR' or rR' morphology (odds ratio: 3.93; 95% CI: 1.46-10.56), r > or = 0.04 s or notched S downstroke or delayed S nadir > 0.06 s in the V1 or the V2 lead (odds ratio: 5.75; 95% CI: 1.26?26.28), and intrinsicoid deflection > or = 0.08 s in the V6 lead (odds ratio: 6.88; 95% CI: 1.33-27.79) were more important parameters. Seven (7) VTs of 103 tachycardias were mis-classified when the Brugada approach was used. Applying additional criteria (QRS width > 0.16 s and intrinsicoid deflection > or = 0.08 s in V6 lead), three of those VTs were diagnosed correctly. CONCLUSIONS: The Brugada algorithm achieved a lower sensitivity and specificity than those reported by Brugada et al. If both the V1 and the V6 leads do not fulfill the criteria for VT, additional parameters should be evaluated.
Diagnosis, Differential* ; Electrocardiography* ; Retrospective Studies ; Sensitivity and Specificity ; Tachycardia* ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

Adolescent ; Atrial Appendage ; Diagnostic Errors ; Female ; Humans ; Tachycardia, Ectopic Atrial ; diagnosis ; Tachycardia, Sinus ; diagnosis

OBJECTIVES: Accurate differential diagnosis of paroxysmal supraventricular tachycardia (PSVT) has become more important after introduction of curative catheter ablation technique into clinical practice. It has been reported that ST-T changes during supraventricular tachycardia are frequent, but its association is different according to the type of PSVT and the location of the AV bypass tracts. Therefore, this study was performed to evaluate the significance of ST-T changes in addition to classic ECG parameters in differentiating AV nodal reentrant tachycardia (AVNRT) and AV reentrant tachycardia (AVRT), and predicting the location of the AV bypass tracts. METHODS: One hundred thirty patients presenting with narrow-QRS complex (<120 msec) regular tachycardia in whom the mechanism of the tachycardia was later confirmed as AVNRT or AVRT by electrophysiologic study (EPS) with successful catheter ablation were included in this study. Tachycardia cycle length, visible P wave, pseudo r' wave in V1, pseudo s wave in the inferior leads, QRS alternation, ST segments depression, and T wave inversion were evaluated in the ECGs recorded during spontaneous episodes of the PSVT and compared between patients with AVNRT (n=54) and AVRT (n=76). RESULTS: Tachycardia cycle lengths were not different between AVNRT and AVRT (355.8 +/- 50.6 msec vs. 341.9 +/- 51.4 msec). P wave during the tachycardia was significantly more frequently seen in AVRT than AVNRT, (72.4% vs. 9.3%, p<0.0001). However, pseudo r' wave and pseudo s wave were significantly more frequent in AVNRT than AVRT (59.3% vs. 7.9%, 33.3% vs. 1.3%, respectively, p<0.0001). QRS alternation was significantly more frequent in AVRT than AVNRT (34.2% vs. 11.1%, p<0.05). ST segment depression > or =1 mm was observed in 27.8% of AVNRT and 79.9% of AVRT (p<0.001). T wave inversion was more frequent in AVRT than AVNRT (30.3% vs. 7.4%, p<0.01). ST depression > or =2 mm was observed in 76.9% of the left posterior pathways, 28.1% of the left anterolateral pathways, 66.7% of the right posterior pathways, and 1.1% of the right anterior pathways. Sensitivity, specificity, and positive predictive value in differentiating AVRT from AVNRT with visible p wave were 72%, 91%, and 92%, respectively : 78%, 72%, and 80%, respectively with ST segment depression > or =1 mm, and 30%, 93%, and 85%, respectively with T wave inversion. In differentiating AVNRT from AVRT, Sensitivity, Specificity, and positive predictive value of pseudo r' wave and pseudo s wave were 59%, 92%, 84%, respectively and 33%, 99%, 94%, respectively. Sensitivity, specificity, and positive predictive value in distinguishing posterior location from anterior location of the pathways were 74%, 76%, and 72%, respectively with ST segment depression (> or =2 mm) and 46%, 83%, and 70%, respectively with T wave inversion. CONCULSIONS: ST Segment depression during PSVT can be used complementally to the classic ECG parameters in the differential diagnosis of PSVT and predicting the location of the AV bypass tracts.
Catheter Ablation ; Complement System Proteins ; Depression ; Diagnosis, Differential* ; Electrocardiography* ; Humans ; Sensitivity and Specificity ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular*

To investigate the value of ventricular tachycardia (VT) score in diagnosing pre-excited tachycardia.
 Methods: Twelve-lead electrocardiograph results were obtained from 30 patients at pre-excited tachycardia attacking stage who were diagnosed by electrophysiology. We scored pre-excitation tachycardia based on the VT score. To analyze the electrocardiogram of pre-excited tachycardia using 7 diagnostic indicators of the VT score and calculate the specificity of 7 diagnostic indicators and right superior axis (-90º to ±180º), the differences were compared among VT score of 2 points and brugada, Wellens, and Vereckei algorithms in diagnosing pre-excited tachycardia. According to the specificity of Vereckei, Wellens, and Brugada algorithms, and VT scores from low to high, their prediction value and differences were analyzed.
 Results: Single indicator such as atrioventricular (AV) dissociation or right superior axis (-90º to ±180º) showed the highest specificity (100%) for identifying pre-excited tachycardia. No patient with VT score was ≥3 points, and the specificity was 100%. The specificity of VT score of 2 point was higher than that of Brugada, Wellens, or Vereckei algorithms in the diagnosing pre-excited tachycardia (76.7% vs 50.0%, 23.3% or 20.0%, P<0.05). The specificity of Vereckei, Wellens, and Brugada algorithms and VT score were gradually increased after each of stepwise individually eliminated VT (20.0%, 40.0%, 66.7%, 83.3%, P<0.05). However, there was no significant difference in the specificity in the remaining false positive cases between the 4 methods and VT score.
 Conclusion: VT score ≥3 points can identify pre-excited tachycardia and VT with 100% specificity. VT score of 2 points cannot completely distinguish pre-excited tachycardia from VT, but specificity of VT score with 2 points is obviously higher than that of Brugada, Wellens, and Vereckei algorithms.
Algorithms ; Diagnosis, Differential ; Electrocardiography ; Humans ; Sensitivity and Specificity ; Tachycardia, Ventricular ; diagnosis

We discuss two cases of incessant atrial tachycardia (AT), including the presentation and clinical course. It is important to differentiate AT from other causes of supraventricular tachycardia, such as atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT), as it would have implications on clinical management. Electrocardiographic features of AT, especially the presence of an AV Wenckebach phenomenon with 'grouped beating', are critical for differentiating AT from AVRT and AVNRT. It is also vital to identify the P waves and their relations to QRS on electrocardiography, as this would aid in the differentiation of various supraventricular tachycardias.
Aged ; Diagnosis, Differential ; Electrocardiography ; Electrophysiology ; Female ; Heart Conduction System ; abnormalities ; Hemodynamics ; Humans ; Male ; Respiration ; Tachycardia ; diagnosis ; Tachycardia, Atrioventricular Nodal Reentry ; diagnosis ; Tachycardia, Supraventricular ; diagnosis ; Tricuspid Valve ; physiopathology