Supraventriküler Taşikardilerin Ayırıcı Tanısında Yaş ve Cinsiyetin Önemi

Yıl 2019, Cilt: 22 Sayı: 3, 162 - 167, 24.12.2019

Kürşat Akbuğa , Murat Eren Mustafa Karanfil Turgay Aslan İlknur Can

Öz

Giriş: Supraventriküler taşikardilerin ayırıcı tanısı için birçok algoritma önerilmiştir. Bununla birlikte, bu algoritmaların farklı cinsiyet ve yaş grupları üzerindeki etkisi araştırılmamıştır. Amacımız, bilinen elektrokardiyografi (EKG) parametrelerinin farklı yaş ve cinsiyet gruplarındaki dağılımını gözlemlemektir.

Hastalar ve Yöntem: Retrospektif olarak, taşikardi esnasında EKG’si olan ve elektrofizyoloji çalışması (EPS) veya radyofrekans ablasyonu (RF) ile atriyoventriküler nodal reentrant taşikardi (AVNRT) veya atriyoventriküler reentrant taşikardi (AVRT) tanısı alan 114 hastanın EKG parametreleri incelenmiştir.

Bulgular: Kadınlar için V1 ve aVR’de yalancı r’-dalgaları AVNRT grubunda daha anlamlıydı (p< 0.05); QRS alternansı AVRT grubunda anlamlıydı (p< 0.05). AVNRT grubunda 60 yaşın altındaki bireylerde sağ prekordiyalde ST depresyonu anlamlı görüldü; aynı gruptaki 60 yaşın üzerindeki bireyler için, yukarı eğimli ST depresyonu anlamlı bir parametre olarak saptandı (p< 0.05). Altmış yaş üstündeki AVRT hastalarında ortalama ST depresyon amplitüdünün ortalaması, 60 yaş altındakilere göre daha yüksekti (p< 0.05).

Sonuç: Bu çalışmada bilinen EKG parametrelerinin yaşa ve cinsiyete göre farklılık gösterdiği gösterilmiştir. SVT ayırıcı tanı ve algoritmalarında yaş ve cinsiyetin yer alabileceği ortaya koyulmuştur.

Anahtar Kelimeler

Atriyoventriküler nodal re-entran taşikardi, atriyoventriküler resiprokal taşikardi, ayırıcı tanı, elektrokardiyografi

Value of Age and Sex in Differential Diagnosis of Supraventricular Tachycardia

Öz

Introduction: Many algorithms have been proposed for the differential diagnosis of supraventricular tachycardia (SVT). However, the effect of these algorithms on different sex and age groups has not been investigated. Our aim in this study is to observe the distribution of known electrocardiography (ECG) parameters in different age and sex groups.

Patients and Methods: The ECG parameters (during tachycardia) of 114 patients diagnosed with atrioventricular nodal re-entrant tachycardia (AVNRT) or atrioventricular re-entrant tachycardia (AVRT) by electrophysiology or radiofrequency ablation were evaluated retrospectively.

Results: For women, pseudo r’-waves in V1 and in aVR were significant in the AVNRT group (p< 0.05), whereas the QRS alternans was significant in the AVRT group (p< 0.05). In the AVNRT group, the ST depression in the right precordial leads was found to be significant in individuals aged < 60 years; the up-sloping ST depression was found to be a significant parameter for individuals aged > 60 years in the same group (p< 0.05). The mean ST depression amplitude was higher in the AVRT patients aged > 60 years than individuals aged < 60 years in the same group (p< 0.05).

Conclusion: In this study, it was shown that known ECG parameters differ according to age and gender. It was also demonstrated that age and gender may be included in the SVT differential diagnosis and algorithms.

Anahtar Kelimeler

Atrioventricular nodal re-entrant tachycardia, atrioventricular reciprocating tachycardia, differential diagnosis, electrocardiography

Kaynakça

• 1. Farré J, Wellens HJJ. The value of the electrocardiogram in diagnosing site of origin and mechanism of supraventricular tachycardia. In: Farré J, Wellens HJJ (eds). What’s New in Electrocardiography. Dordrecht: Springer Netherlands, 1981:131-71.
• 2. Akhtar M, Jazayeri MR, Sra J, Blanck Z, Deshpande S, Dhala A. Atrioventricular nodal reentry. Clinical, electrophysiological, and therapeutic considerations. Circulation 1993;88:282-95.
• 3. Kalbfleisch SJ, El-Atassi R, Calkins H, Langberg JJ, Morady F. Differentiation of paroxysmal narrow QRS complex tachycardias using the 12-lead electrocardiogram. J Am Coll Cardiol 1993;21:85-9.
• 4. Riva SI, Della Bella P, Fassini G, Carbucicchio C, Tondo C. Value of analysis of ST segment changes during tachycardia in determining type of narrow QRS complex tachycardia. J Am Coll Cardiol 1996;27:1480-5.
• 5. Tai CT, Chen SA, Chiang CE, Lee SH, Wen ZC, Chiou CW, et al. A new electrocardiographic algorithm using retrograde P waves for differentiating atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway. J Am Coll Cardiol 1997;29:394-402.
• 6. Di Toro D, Hadid C, López C, Fuselli J, Luis V, Labadet C. Utility of the aVL lead in the electrocardiographic diagnosis of atrioventricular node re-entrant tachycardia. Europace 2009;11:944-8.
• 7. González-Torrecilla E, Almendral J, Arenal A, Atienza F, Atea LF, del Castillo S, et al. Combined evaluation of bedside clinical variables and the electrocardiogram for the differential diagnosis of paroxysmal atrioventricular reciprocating tachycardias in patients without pre-excitation. J Am Coll Cardiol 2009;53:2353-8.
• 8. Haghjoo M, Bahramali E, Sharifkazemi M, Shahrzad S, Peighambari M, et al. Value of the aVR lead in differential diagnosis of atrioventricular nodal reentrant tachycardia. Europace 2012;14:1624-8.
• 9. Filgueiras Medeiros J, Nardo-Botelho FM, Felix-Bernardes LC, Hollanda-Oliveira L, Bassolli de Oliveira-Alves L, Lúcia-Coutinho Ê, et al. Diagnostic accuracy of several electrocardiographic criteria for the prediction of atrioventricular nodal reentrant tachycardia. Arch Med Res 2016;47:394-400.
• 10. Cheng J. Evidences of the gender-related differences in cardiac repolarization and the underlying mechanisms in different animal species and human. Fundam Clin Pharmacol 2006;20:1-8.
• 11. Linde C, Bongiorni MG, Birgersdotter-Green U, Curtis AB, Deisenhofer I, Furokawa T, et al; ESC Scientific Document Group. Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm-Society. Europace 2018;20:1565-1565ao.
• 12. Maury P, Zimmermann M, Metzger J. Distinction between atrioventricular reciprocating tachycardia and atrioventricular node re-entrant tachycardia in the adult population based on P wave location; should we reconsider the value of some ECG criteria according to gender and age? Europace 2003;5:57-64.
• 13. Porter MJ, Morton JB, Denman R, Lin AC, Tierney S, Santucci PA, et al. Influence of age and gender on the mechanism of supraventricular tachycardia. Heart Rhythm 2004;1:393-6.
• 14. Liuba I, Jonsson A, Safstrom K, Walfridsson H. Gender-related differences in patients with atrioventricular nodal reentry tachycardia. Am J Cardiol 2006;97:384-8.
• 15. Anand RG, Rosenthal GL, Van Hare GF, Snyder CS. Is the mechanism of supraventricular tachycardia in pediatrics influenced by age, gender or ethnicity? Congenit Heart Dis 2009;4:464-8.
• 16. Letsas KP, Weber R, Siklody CH, Mihas CC, Stockinger J, Blum T, et al. Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway. Acta Cardiol 2010;65:171-6.