Combined Evaluation of Bedside Clinical Variables and the Electrocardiogram for the Differential Diagnosis of Paroxysmal Atrioventricular Reciprocating Tachycardias in Patients Without Pre-Excitation
Esteban González-Torrecilla, MD, PhD*,
Jesús Almendral, MD, PhD,
Angel Arenal, MD,
Felipe Atienza, MD, PhD,
Leonardo F. Atea, MD,
Silvia del Castillo, MD and
Francisco Fernández-Avilés, MD, PhD
Hospital General Universitario Gregorio Marañón, Cardiology Department, Madrid, Spain
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Figure 1 ECG Typical Examples of Paroxysmal AV Reciprocating Tachycardias
Twelve-lead electrocardiogram (ECG) of a typical atrioventricular nodal re-entrant tachycardia (AVNRT) (A) showing clear pseudo-r' (V1) and pseudo S waves (inferior leads [asterisks]) (sinus beat for comparison) and examples of atypical AVNRT (B), an AVNRT tracing without identifiable pre-specified positive ECG findings (C), and an orthodromic reciprocating tachycardia case with a concealed accessory pathway (D). Clear retrograde p waves are observed in B and D (arrowheads).
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Figure 2 Age at Symptom Onset ROC Curve
Age at the onset of symptoms receiver-operator characteristic (ROC) curve. The cut-point that better optimizes the values of sensitivity and specificity for an atrioventricular nodal re-entrant tachycardia diagnosis is for age values  30 years (C statistic: 0.711, SE: 0.03; p = 0.0001).
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Figure 3 Comparison of ROC Curves
Receiver-operator characteristic (ROC) curves for atrioventricular nodal re-entrant tachycardia diagnosis (vs. orthodromic reciprocating tachycardia). The curves are based on diagnosis-prediction models incorporating 3 selected clinical covariates that either included the presumptive electrocardiographic diagnosis (C statistic: 0.81 [SE: 0.025, p = 0.0001; asymptotic 95% confidence interval: 0.762 to 0.859] area under black line) or did not include that information (C statistic: 0.755 [SE: 0.027, p = 0.0001; asymptotic 95% confidence interval: 0.701 to 0.808] dark pink area) (p = 0.003). For practical purposes, age at onset of symptoms is included in these models as a dichotomized variable (30 years).
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