DIFFERENTIATION OF REGULAR, NARROW-QRS COMPLEX TACHYCARDIA TYPES BY UTILIZING THE STANDARD 12-LEAD ELECTROCARDIOGRAM
Mohammad A. Shaikhani a, Hemin Sadeeq Mohammed b, and Ammar Al-Hamdi a
a College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
b Directorate of Health, Ministry of Health, Kurdistan Region, Iraq.
Submitted: 19/11/2020; Accepted: 23/5/2021; Published: 21/12/2021
DOI Link: https://doi.org/10.17656/jsmc.10332
Supraventricular tachycardia comprises 80% of regular tachycardia that present to the emergency rooms and cardiology clinics. It is of many mechanisms and electrocardiography features. In a high percentage of cases, it occurs in the structurally-normal heart. Epidemiologically it has been discovered that it is more widespread in females than in males.
Electrocardiography (ECG) criteria help differentiate the types of Supraventricular tachycardia (SVT) and predict the underlying mechanism. For example, the patient with short R.P. and long P.R. types is more suggestive of atrioventricular nodal reentrant tachycardia (AVNRT), where ablation therapy is more successful than in atrial tachycardia and atrioventricular reentrant tachycardia (AVRT)
Differentiating between AVNRT, AVRT, and atrial tachycardia is extremely significant regarding the acute termination by medications; Adenosine and Calcium-channel blockers (CCBs) are found more effective in atrioventricular reentrant tachycardia, CCBs should be avoided in long R.P. and short P.R.
Patients and Methods
A retrospective cross-sectional study was conducted between December 2016 and February 2018. This study included patients who visited the emergency room with a narrow-QRS-complex tachycardia.
Eighty-five patients with regular narrow-QRS-complex tachycardia were included. The mean ± S.D. of the participants-age was 46.29 years ±12.71, 56 cases (65.9%) were females, and 29 (34.1%) were males. The mean ± S.D. of the disease duration of the condition was 5.07±5.52 years, and a frequency of 3.8 attacks per 6 months, and a mean duration of each episode was approximately 80 minutes for each episode. Regarding the symptomatology of tachycardia, almost all patients had symptoms of palpitation, 11.8% had presyncope, and 4.7% had syncope.
Atrioventricular nodal reentries tachycardia (slow/fast) are the most common in our study. AVRNT was found more prevalent in females than males. Atrioventricular reentry tachycardia was found in males more than females in our study.
Supraventricular tachycardia; PR interval; electrocardiograph record; Gender.
Kass RE, Clancy CE, editors. Basis and treatment of cardiac arrhythmias. Springer Science & Business Media; 2005 Sep 29.
Sganzerla P, Fabbiocchi F, Grazi S, Cipolla C, Moruzzi P, Guazzi MD. Electrophysiologic and haemodynamic correlates in supraventricular tachycardia. European heart journal. 1989 Jan 1;10(1):32-9.
Hamdan MH, Zagrodzky JD, Page RL, Wasmund SL, Sheehan CJ, Adamson MM, et al. Effect of P-wave timing during supraventricular tachycardia on the hemodynamic and sympathetic neural response. Circulation. 2001 Jan 2;103(1):96-101.
Fuster, V., Ryden, L.E. and Asinger, R.W., 2001. guidelines for the management of patients with atrial fibrillation: executive summary report of the ACC/AHA Task Force on practice guidelines and the ESC Committee for practice guidelines and policy conferences (committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Circulation, 104, pp.2118-2150.
Blomstrom-Lundqvist, C. "European Society of Cardiology Committee, NASPE-Heart Rhythm Society. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart ...." J Am Coll Cardiol 42 (2003): 1493-1531.
Ganz LI, Friedman PL. Supraventricular tachycardia. New England Journal of Medicine. 1995 Jan 19;332(3):162-73.
Fenelon G, Wijns W, Andries E, Brugada P. Tachycardiomyopathy: mechanisms and clinical implications. Pacing and Clinical Electrophysiology. 1996 Jan;19(1):95-106.
Kumar UN, Rao RK, Scheinman MM. The 12-lead electrocardiogram in supraventricular tachycardia. Cardiology clinics. 2006 Aug 1;24(3):427-37.
Wellens HJ, Brugada P. Mechanisms of supraventricular tachycardia. The American journal of cardiology. 1988 Aug 25;62(6):10-5.
Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 2016 Apr 5;67(13):e27-115.
Denes P, Wu D, DHINGRA RC, Chuquimia R, ROSEN KM. Demonstration of dual AV nodal pathways in patients with paroxysmal supraventricular tachycardia. Circulation. 1973 Sep;48(3):549-55.
Rosen KM, Mehta A, Miller RA. Demonstration of dual atrioventricular nodal pathways in man. The American journal of cardiology. 1974 Feb 1;33(2):291-4.
Akhtar M, Jazayeri MR, Sra J, Blanck Z, Deshpande S, Dhala A. Atrioventricular nodal reentry. Clinical, electrophysiological, and therapeutic considerations. Circulation. 1993 Jul;88(1):282-95.
Waldo AL, Wit AL. Mechanisms of cardiac arrhythmias. The Lancet. 1993;341(8854):1189-93.
Erdinler I, Okmen E, Oguz E, Akyol A, Gurkan K, Ulufer T. Differentiation of narrow QRS complex tachycardia types using the 12-lead electrocardiogram. Annals of noninvasive electrocardiology. 2002 Apr;7(2):120-6.
Porter MJ, Morton JB, Denman R, Lin AC, Tierney S, Santucci PA, Cai JJ, Madsen N, Wilber DJ. Influence of age and gender on the mechanism of supraventricular tachycardia. Heart Rhythm. 2004 Oct 1;1(4):393-6.
Dogan H, Ozucelik DN, Aciksari K, Caglar IM, Okutan N, Yazicioglu M, et al. To decide medical therapy according to ECG criteria in patients with supraventricular tachycardia in emergency department: adenosine or diltiazem. International journal of clinical and experimental medicine. 2015;8(6):9692.
Lim SH, Anantharaman V, Teo WS. Slow-infusion of calcium channel blockers in the emergency management of supraventricular tachycardia. Resuscitation. 2002 Feb 1;52(2):167-74.
Jr WJ, DeBehnke DJ, Wickman LL, Lindbeck G. Treatment of out-of-hospital supraventricular tachycardia: adenosine vs verapamil. Academic Emergency Medicine. 1996 Jun;3(6):574-85.
Cheng KA. Intravenous Adenosine versus Verapamil in Terminating Episodes of Paroxysmal Supraventricular Tachycardia Study G.[A randomized, multicenter trial to compare the safety and efficacy of adenosine versus verapamil for termination of paroxysmal supraventricular tachycardia]. Zhonghua Nei Ke Za Zhi. 2003;42(11):773-6.
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