Abstract
Background: We hypothesized that signal averaged ECG during tachycardia
would facilitate P wave recognition and assist in SVT diagnosis. P waves
adjacent to the QRS during tachycardia would lengthen the filtered QRS
and be recognized by subtracting QRS duration during sinus rhythm from
that of tachycardia. Aims: to assess the feasibility of SaECG during
SVT; to correlate the difference between the filtered QRS duration in
SVT and sinus rhythm (ΔfQRSd) with the endocardial VA time; Methods &
Results: Patients referred for an EP study and ablation of any SVT were
included. A SAECG was acquired during SVT and compared with another
during SR. 40 patients were included, 20 had AVNRT and 20 AVRT. For
AVNRT, the P wave was detected as a pseudo-late potential in 16
patients. In 4 patients, P wave was invisible and presumed within the
confines of the QRS. The mean ΔfQRSd was 2017 ms and the VA time was
1415 ms. For AVRT a distinct P wave separated from the QRS was detected
in all patients. The ΔfQRSd was 10742ms and the VA time was 9631 ms.
ΔfQRSd was longer during AVRT than AVNRT (p<0.0001). Over all,
the ΔfQRSd correlated with the longest VA time (R=0.796). Motion
artifact and sensing of T waves during tachycardia were 2 confounders.
Conclusion: SaECG provides a rapid adjunct to the 12 lead ECG and is
capable of identifying P waves and facilitating diagnosis of SVT
mechanism.