title: Validation of Standard and New Criteria for the Differential Diagnosis of Narrow QRS Tachycardia in Children and Adolescents.
abstract: To establish an appropriate treatment strategy and determine if ablation is indicated for patients with narrow QRS complex supraventricular tachycardia (SVT), analysis of a standard 12-lead electrocardiogram (ECG) is required, which can differentiate between the 2 most common mechanisms underlying SVT: atrioventricular nodal reentry tachycardia (AVNRT) and orthodromic atrioventricular reentry tachycardia (OAVRT). Recently, new, highly accurate electrocardiographic criteria for the differential diagnosis of SVT in adults were proposed; however, those criteria have not yet been validated in a pediatric population.All ECGs were recorded during invasive electrophysiology study of pediatric patients (n = 212; age: 13.2 ± 3.5, range: 1-18; girls: 48%). We assessed the diagnostic value of the 2 new and 7 standard criteria for differentiating AVNRT from OAVRT in a pediatric population.Two of the standard criteria were found significantly more often in ECGs from the OAVRT group than from the AVNRT group (retrograde P waves [63% vs 11%, P < 0.001] and ST-segment depression in the II, III, aVF, V1-V6 leads [42% vs 27%; P < 0.05]), whereas 1 standard criterion was found significantly more often in ECGs from the AVNRT group than from the OAVRT group (pseudo r' wave in V1 lead [39% vs 10%, P < 0.001]). The remaining 6 criteria did not reach statistical significance for differentiating SVT, and the accuracy of prediction did not exceed 70%. Based on these results, a multivariable decision rule to evaluate differential diagnosis of SVT was performed.These results indicate that both the standard and new electrocardiographic criteria for discriminating between AVNRT and OAVRT have lower diagnostic values in children and adolescents than in adults. A decision model based on 5 simple clinical and ECG parameters may predict a final diagnosis with better accuracy.
authors.affiliation: From the ELMedica EP-Network, Kielce (KD, SS, JS); Medical University of Warsaw, Warsaw (KD, MG); Department of Electroradiology, University of Rzeszow, Rzeszow (SS); PCISN, G.V.M. Carint, Sanok (SS); Department of Internal Disease and Cardiology, Specialistic Hospital, Gorlice (PK); Department of Cardiosurgery et Cardiosurgical Intensive Care Polish-American Children's Hospital, Jagiellonian University Medical College in Krakow, Krakow (AM); First Department of Cardiology and Interventional Electrocardiology, University Hospital, Cracow (MJ); Department of Paediatric Cardiology, Poznan University of Medical Sciences, Poznan (AB); Department of Pediatrics, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow (MP); Carint-Medica, Cracow (JS); Department of Statistics, Cracow University of Economics, Kracow (KF); Regional Specialist Hospital, Research and Development Centre, Wroclaw (MM, BL); and Department of Pediatric Cardiology, Medical University of Silesia in Katowice, Poland (LS).
authors.forename: Karol
authors.initials: K
authors.lastname: Deutsch
authors.forename: Sebastian
authors.initials: S
authors.lastname: Stec
authors.forename: Piotr
authors.initials: P
authors.lastname: Kukla
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Morka
authors.forename: Marek
authors.initials: M
authors.lastname: Jastrzebski
authors.forename: Artur
authors.initials: A
authors.lastname: Baszko
authors.forename: Maciej
authors.initials: M
authors.lastname: Pitak
authors.forename: Janusz
authors.initials: J
authors.lastname: Sledz
authors.forename: Kamil
authors.initials: K
authors.lastname: Fijorek
authors.forename: Mariusz
authors.initials: M
authors.lastname: Mazij
authors.forename: Bartosz
authors.initials: B
authors.lastname: Ludwik
authors.forename: Marcin
authors.initials: M
authors.lastname: Gubaro
authors.forename: Leslaw
authors.initials: L
authors.lastname: Szydlowski
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis*; D054139:Tachycardia, Reciprocating / Q000175:diagnosis