Arrhythmias and conduction disturbancesUsefulness of ST-segment elevation in lead aVR during tachycardia for determining the mechanism of narrow QRS complex tachycardia
Section snippets
Electrocardiographic analysis
A total of 338 12-lead electrocardiograms recorded during paroxysmal supraventricular tachycardia at the time of invasive electrophysiologic studies were analyzed. The inclusion criterion was the presence of a regular narrow QRS complex (<0.11 second) tachycardia with a 1:1 ratio of atrioventricular activity.3 Exclusion criteria were poor isoelectric line recording of 12-lead electrocardiograms during tachycardia, atrial flutter, atrial fibrillation, right and left bundle branch block patterns,
Results
There were 161 episodes of AVNRT, 165 of AVRT, and 12 of AT (right atrial origin). The heart rate during tachycardia was highest in the AVRT group. The IAAT was significantly longer in the AVRT group than that in the AVNRT group (Table 1). There were 169 electrocardiograms with aVR ST-segment elevation, 157 with ST-T changes in inferior leads, and 75 with ST-T changes in precordial leads. The prevalence of aVR ST-segment elevation was 71% for AVRT, 31% for AVNRT, and 16% for AT (p <0.001). The
Discussion
The lead aVR has been largely ignored in that most electrocardiographers consider this lead as giving reciprocal information from the left lateral side.1, 10 Therefore, standard 11-lead electrocardiograms rather than 12-lead electrocardiograms are used by most interpreters.10 However, several studies used the aVR ST-segment elevation during acute myocardial infarction to identify coronary artery lesions.11, 12, 13, 14 Ischemia of the basal part of the interventricular septum causes ST-segment
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Cited by (26)
Diagnostic Accuracy of Several Electrocardiographic Criteria for the Prediction of Atrioventricular Nodal Reentrant Tachycardia
2016, Archives of Medical ResearchCitation Excerpt :However, variation in the diagnostic accuracy among those classical ECG findings is not well known. Electrophysiological (EP) testing has been used to assess the inducibility and mechanism of SVT and to guide catheter ablation using radiofrequency, which has become the preferred treatment for symptomatic SVT (10,22). Accurate prediction of SVT by upfront ECG may be helpful in planning the ablation, potentially decreasing the duration of the procedure, time of radiation and likelihood of complications.
Electrocardiographic applications of lead aVR
2006, American Journal of Emergency MedicineA new criterion to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia: Combined AVR criterion
2018, Journal of ElectrocardiologyCitation Excerpt :In a previous study, ST segment elevation in the aVR was found to indicate AVRT as the tachycardia mechanism [4]. In this study, retrograde P waves in AVRT were thought to cause ST segment elevation [4]. Haghjoo M. et al. [3] showed that a retrograde P wave may cause a pseudo r′ deflection in aVR due to a short VA interval in patients with AVNRT.