Significance of ST-segment Depression during Paroxysmal Supraventricular Tachycardia.
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Date
2015
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Abstract
Background: ST-segment depression in ECG is a common finding during paroxysmal
supraventricular tachycardia. The exact mechanism and etiology of this ST-segment depression is
not always evident. In this study we have tried to evaluate the significance of ST-segment depression
during supraventricular tachycardia.
Methods: Hospitalized patients for elective electrophysiological study with previous (EPS) history
of supraventricular tachycardia with or without ST-segment depression were evaluated clinically,
by coronary angiogram and EPS. Data were analyzed by appropriate statistical methods and
comparison made between groups with ST-segment depression (Group A) and without ST-segment
depression (Group B).
Results: Total number of patients was 66. Equal number of patients (33) was in each group. The
mean age of patients was 43.8 years. There was female predominance (M:F ratio 2:3). The mean heart
rate during supraventricular tachycardia was 161 beats/min. Age, sex, coronary artery disease risk
factors and heart rate during an episode of supraventricular tachycardia did not have any significant
influence on ST-segment depression. Significant coronary artery disease was found in two patients
in Group A and one patient in Group B. Electrophysiological study revealed that Atrio ventricular
reentry tachycardia (AVRT) and AV nodal reentry tachycardia (AVNRT) were present in 28 (42.4%)
and 38 (57.6%) cases respectively. Patients of group A exhibit AVRT significantly more than patients
of group B.The sensitivity of ST-segment depression in correctly diagnosing coronary artery disease
(CAD) was 66.7% while the specificity was 50.8%. The sensitivity of ST-segment depression in
correctly differentiating AVRT was 83.3% while the specificity was 66.7%. The positive predictive
value (PPV) and Negative predictive value (NPV) of the test were 75% and 76.9% respectively.
Conclusion: ST-segment depression during episode of supraventricular tachycardia is a poor
indicator of coronary artery disease. Presence of ST-segment depression can differentiate AVRT
from AVNRT. However, >2 mm ST-segment depression was proved to be an excellent predictor of
AVRT.
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Keywords
ST-segment depression, supraventricular tachycardia, AVRT, AVNRT, Coronary artery disease
Citation
Zaman Shahana, Sayami Lima Asrin, Rahim Muhammad Abdur, Islam A K M Monwarul, Ullah Mohammad, Nabi Shaila, Ali M Atahar. Significance of ST-segment Depression during Paroxysmal Supraventricular Tachycardia. Cardiovascular Journal. 2015; 7(2): 93-97.