Paroxysmal regular supraventricular tachycardia: the diagnostic accuracy of the transesophageal ventriculo-atrial interval.
OBJECTIVE
To establish the diagnostic accuracy of the transesophageal ventriculo-atrial (VA) interval in patients with paroxysmal supraventricular tachycardia (PSVT) and normal baseline electrocardiogram (ECG).


METHODS
The transesophageal VA interval during tachycardia was recorded in 318 patients (age 45 ± 17 years, 58% female) with PSVT and a normal surface ECG between attacks. Subsequently, all patients underwent an ablation procedure establishing the correct tachycardia diagnosis.


RESULTS
AV nodal reentrant tachycardia (AVNRT), AV reentrant tachycardia through a concealed accessory pathway (AVRT), and ectopic atrial tachycardia (EAT) were found in 213, 95, and 10 cases, respectively. Receiver operating characteristic curve analysis identified an optimal cutoff for a binary categorization of AVNRT versus AVRT/EAT at ≤80 ms (area under the curve 0.891). Owing to a biphasic distribution, AVNRT was very likely at VA intervals ≤90 ms with a sensitivity, specificity, and positive predictive value (PPV) of 87%, 91%, and 95%. In the range 91-160 ms the corresponding values for AVRT were 88%, 95%, and 88% (90%, 99%, and 98% in male patients). In the small group with VA intervals >160 ms (n = 29), the diagnosis was less clear (PPV of 67% for AVNRT).


CONCLUSIONS
In patients with sudden onset regular tachycardia and a normal ECG during sinus rhythm, a transesophageal VA interval of ≤80 ms has the highest diagnostic accuracy to diagnose AVNRT versus AVRT/EAT. Overall, the biphasic distribution of VA intervals suggests considering AVNRT at 90 ms and below and AVRT between 91 and 160 ms (in particular in male patients) while the diagnosis is vague at VA intervals above 160 ms.
Electrophysiology & Arrhythmia Service, Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. frieder.braunschweig@karolinska.se
Frieder
F
Braunschweig
Petra
P
Christel
Mats
M
Jensen-Urstad
Mats
M
Andersson
Jonas
J
Schwieler
Jari
J
Tapanainen
Hamid
H
Bastani
Fredrik
F
Gadler
Cecilia
C
Linde
Wolfgang
W
Schöls
Lennart
L
Bergfeldt
D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000503:physiopathology; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000503:physiopathology