Acurácia dos critérios clínicos e eletrocardiográficos em predizer o diagnóstico de taquicardia por reentrada nodal

• Ano de defesa: 2018
• Autor(a) principal: Medeiros, Juliana Filgueiras [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Tachyarrhythmia; Tachycardia; Ablation; Atrioventricular nodal reentrant tachycardia; Taquiarritmia; Taquicardia; Ablação; Taquicardia por reentrada nodal
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6526153; https://repositorio.unifesp.br/handle/11600/52108

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia (SVT), whose diagnosis can be strongly suspected based on the surface eletrocardiogram alone. Aim of the study: The purpose of this study is to determine the diagnostic accuracy of several electrocardiographic (ECG) criteria for the prediction of AVNRT. Methods —Between November 2010 and January 2014, a total of 256 patients who underwent electrophysiological testing (EP) with regular, paroxysmal and narrow QRS complex tachycardia were prospectively enrolled. We classified the ECG recordings during tachycardia for the presence of the following criteria: 1) classical ECG findings of pseudo S wave in inferior leads and/or pseudo R’ wave in lead V1, 2) notch in lead aVL, 3) no retrograde P waves visible during tachycardia; 4) pseudo r’ wave in lead aVR, 5) notch in lead D1, 6) any deflection after 100 ms of the QRS complex during tachycardia. Results: On multivariate analysis, independent predictors of AVNRT diagnosis were: female sex (OR 4.17;CI 95% [2.11 8.24] ; p<0.001), age > 60 years (OR 3.53;CI 95% [1.25 9.96] ; p=0.017) and the classical ECG criteria (OR 7.41;CI 95% [3.62 15.17] ; p<0.001). Conclusions: Female, age > 60 years and the classical ECG criteria were the independent predictors of AVNRT diagnosis. Although several of the ECG criteria for AVNRT diagnosis showed acceptable sensitivities and specificities, they do not improve its accuracy.