Value Of Transesophageal Eletrophysiologic Study In The Differential Diagnosis Of Wide QRS Complex Tachycardia

ObjiectiveTo investigate the value of transesophageal eletrophysiologic study in the differential diagnosis of wide QRS complex tachycardia(WCT).Method114patients, coming to our hospital and accepting transesophageal eletrophysiologic study from October,2011to February,2014, was included the study, including33cases whose tachycardia were spontaneous and81cases induced by the study. All the cases was accordance with the standard of WCT, and had no absolute contraindication of transesophageal eletrophysiologic study. Firstly,7F quadrupole transesophageal electrode was placed through nasal cavity to esophageal, and the study was accomplished with DF-5A electrophysiological stimulator. The electrocardiogram(ECG), esophageal electrocardiogram (ESO),or filtered bipolar esophageal electrocardiogram (EB) of tachycardia was record. Secondly, ECG were analysed and diagnosed according to Brugada4steps algorithms, aVR lead4steps algorithms, R-wave peak time (RWPT) respectively. Besides, the diagnosis of tachycardia were made by analyzing the relationship between atrium and ventricle according to ESO(or EB), and the QRS morphological change during transesophageal atrial pacing (TEAP) if the relationship was1:1. Finally,according to the gorden standard-eletrophysiologic study(EPS), the difference of total accuracy, and specificity, sensitivity, positive predictive value, negative predictive value for ventricular tachycardia was be made between transesophageal eletrophysiologic study and3ECG algorithms.Result1. There were55VT(48.2%), and59SVT(51.5%) of the114cases; for the spontaneous tachycardia, including33cases,27(81.8%) were VT and6(18.2%) were SVT, however, for the induced tachycardia, incuding81cases,28(34.6%) were VT and53(65.4%) were SVT. The proportion of VT spontaneously was higher than the induced one, and difference was statistically significant (p<0.05)2.99cases,86.85%, were diagnosed correctly, however,5VT and10SVT wrong according to Brugada4steps algorithms;79cases,69.3%, were diagnosed correctly, however,11VT and24SVT wrong according to aVR lead4steps algorithms;71cases,62.3%, were diagnosed correctly, but35VT and8SVT wrong according to RWPT.114cases were diagnosed correctly,99.1%,and only1case, SVT, wrong according to transesophageal eletrophysiologic study, which includes two steps-firstly,47cases could be diagnosed just according to ESO(or EB),and the accuracy were100%, sensitivity, specificity for VT being 83.6%,100%; secondly,67cases relationship of atrium and ventricle being1:1, were diagnosed by TEAP, and the accuracy were99.1%, sensitivity, and specificity for VT being98.2%,100%.3. The accuracy of transesophageal eletrophysiologic study is higher than the other3ECG algorithms (p<0.05); its senstivity was,98.2%(95%CI89.0%～99.9%), higher than aVR and RWPT algorithms (p<0.05); its specificity was,100%(95%CI92.4%～100%), higher than the other3ECG algorithms (p<0.05); its positive predictive value,100%(95%CI91.7%～100%), is higher than the other3ECG algorithms, and negative predictive value,98.3%(95%CI89.8%～99.9%), higher than aVR and RWPT algorithms.4. The mechanism of59SVT demonstrated by transesophageal eletrophysiologic study were3intra-atrial reentrant tachycardia(1case with bundle blcok,2cases with functional conduction defects),1atrial flutter conducting through accessory pathway,11atrioventricualr node reentrant tachycardia(4case with bundle blcok,7cases with functional conduction defects),42orthodromic atrioventricular reentrant tachycardia (16cases with bundle blcok,26cases with functional conduction defects),2antidromic atrioventricular reentrant tachycardia, which, excluding2missed diagnosis of dual pathway, was accordance with eletrophysiologic study.5.58SVT was terminated successfully by TEAP, effective rate 98.3%(58/59);but only4VT was terminated by that, effective rate7.3%(4/55).The successful rate of termination SVT is higher than VT, which was statistically significant(p<0.05).ConclusionFor its high accuracy, sensitivity, specificity, positive predict value and negative predict value for ventricular tachycardia,and with the advantage of termination SVT immediately, transesophageal eletrophysiologic study play an important role in differential diagnosis wide QRS tachycardia.