Comparison of standard and Lewis ECG in detection of atrioventricular dissociation in patients with wide QRS tachycardia.
BACKGROUND
The atrioventricular (AV) dissociation, which is frequently used in differential diagnosis of wide QRS complex tachycardia (WQCT), is the most specific finding of ventricular tachycardia (VT) with lower sensitivity. Herein, we aimed to show the importance of Lewis lead ECG records to detect 'visible p waves' during WQCT.


METHODS
A total of 21 consecutive patients who underwent electrophysiologic study (EPS) were included in the study. During EPS, by using a quadripolar diagnostic catheter directed to the right ventricular apex, a fixed stimulus was given and the ventriculoatrial (VA) Wenkebach point was found, and a VT was simulated by a RV apical stimulus at 300ms. The standard and Lewis lead ECG records were taken during this procedure.


RESULTS
We detected 'visible p waves' in 7 (33.3%) and 14 (66.7%) patients in the standard and Lewis lead ECG groups, respectively. In terms of the 'visible p waves', there was a statistically significant difference between groups (p=0.022). The sensitivity of standard and Lewis lead ECG in determination of the visible p waves was 33.3% and 66.7%, respectively.


CONCLUSIONS
The Lewis lead ECG can be more informative about AV dissociation than the standard 12 lead ECG. As a result, we could suggest the assessment of the Lewis lead ECG recording in addition to the standard 12 lead ECG in differential diagnosis of VT in patients with WQCT.
Kars State Hospital, Department of Cardiology, Kars, Turkey. Electronic address: aksuuu001@msn.com.
Uğur
U
Aksu
Erzurum Education and Research Hospital, Department of Cardiology, Erzurum, Turkey.
Kamuran
K
Kalkan
Atatürk University, Faculty of Medicine, Department of Cardiology, Erzurum, Turkey.
Oktay
O
Gülcü
Atatürk University, Faculty of Medicine, Department of Cardiology, Erzurum, Turkey.
Selim
S
Topcu
Atatürk University, Faculty of Medicine, Department of Cardiology, Erzurum, Turkey.
Serdar
S
Sevimli
Atatürk University, Faculty of Medicine, Department of Cardiology, Erzurum, Turkey.
Enbiya
E
Aksakal
Erzurum Education and Research Hospital, Department of Cardiology, Erzurum, Turkey.
Emrah
E
Ipek
Atatürk University, Faculty of Medicine, Department of Cardiology, Erzurum, Turkey.
Mahmut
M
Açıkel
Atatürk University, Faculty of Medicine, Department of Cardiology, Erzurum, Turkey.
Ibrahim Halil
IH
Tanboğa
D000328:Adult; D000368:Aged; D004562:Electrocardiography / Q000295:instrumentation / Q000592:standards*; D004566:Electrodes / Q000592:standards; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation / Q000592:standards; D005260:Female; D006327:Heart Block / Q000175:diagnosis* / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000503:physiopathology*
Electrocardiography; Electrophysiology; Lewis ECG; Ventricular tachycardia