title: Combined evaluation of bedside clinical variables and the electrocardiogram for the differential diagnosis of paroxysmal atrioventricular reciprocating tachycardias in patients without pre-excitation.
abstract: OBJECTIVE
  The aim of this study was to assess the independent predictive contribution to the electrocardiogram (ECG) of bedside clinical variables to distinguish the major forms of paroxysmal supraventricular tachycardias.
  
  
  BACKGROUND
  Atrioventricular nodal re-entrant tachycardias (AVNRTs) and orthodromic reciprocating tachycardias (ORTs), through concealed accessory pathways, are major mechanisms of paroxysmal atrioventricular re-entrant tachycardias.
  
  
  METHODS
  We prospectively included 370 consecutive patients undergoing an electrophysiologic study for paroxysmal, regular, narrow-QRS complex tachycardias without pre-excitation in sinus rhythm. A diagnostic interpretation of ECG recordings was performed by 2 observers blinded to invasive diagnosis used as gold standard. The independent diagnostic contribution of basic clinical variables from a 7-item questionnaire was analyzed alone and in combination with the ECG interpretation by stepwise logistic regression.
  
  
  RESULTS
  AVNRTs and ORTs were demonstrated in 262 and 108 patients, respectively. Age at symptom onset (odds ratio [OR]: 1.27), presence of palpitations in the neck (OR: 3.54), and female sex (OR: 2.96) (all p = 0.0001) were the clinical variables with significant diagnostic power for AVNRT diagnosis. These variables were selected by the logistic model as predictors of the tachycardia diagnosis when the ECG interpretation was included in the analysis (C statistic = 0.81 vs. 0.75 with clinical variables alone; p = 0.003). Neck palpitation was the only predictor of AVNRT when positive ECG findings were lacking.
  
  
  CONCLUSIONS
  Age at the onset of symptoms, sensation of rapid regular pounding in the neck during tachycardia, and female sex are the only significant clinical variables in the differential diagnosis of paroxysmal atrioventricular reciprocating tachycardias in patients without pre-excitation in sinus rhythm. Their consideration adds significant diagnostic information to the ECG.
authors.affiliation: Hospital General Universitario Gregorio Marañón, Cardiology Department, Madrid, Spain. etorrecilla@telefonica.net
authors.forename: Esteban
authors.initials: E
authors.lastname: González-Torrecilla
authors.forename: Jesús
authors.initials: J
authors.lastname: Almendral
authors.forename: Angel
authors.initials: A
authors.lastname: Arenal
authors.forename: Felipe
authors.initials: F
authors.lastname: Atienza
authors.forename: Leonardo F
authors.initials: LF
authors.lastname: Atea
authors.forename: Silvia
authors.initials: S
authors.lastname: del Castillo
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis*; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis*; D055815:Young Adult