Value of physical signs in the diagnosis of ventricular tachycardia.

Abstract:

BACKGROUND:Although the use of physical signs for the diagnosis of ventricular tachycardia (VT) was described in the early 1900s, their value in this role has never been systematically assessed. METHODS AND RESULTS:Using a blinded, randomized protocol, we examined the ability of 26 clinicians to detect ventriculoatrial (VA) dissociation during cardiac pacing in 21 patients with both atrial and ventricular pacing wires in situ after successful ablation of accessory pathways. In protocol 1 (10 patients), pacing was randomized to either ventricular pacing alone (simulating VT) or to atrioventricular sequential pacing (simulating supraventricular tachycardia or VT with intact VA conduction) at rates of 150 or 180 beats per minute. Each patients was examined by four clinicians blinded to the pacing mode. Clinicians were asked to make a diagnosis of "VA association" or "VA dissociation" after examining the patient for variability of the arterial pulse, jugular venous pulse (JVP), and first heart sound. In protocol 2 (11 patients), randomization of pacing mode was performed between examination of each of the three physical signs so that the value of each sign was assessed individually. In protocol 1, a diagnosis of VA dissociation (VT) was made in 21 of 40 observations, with a specificity of 75%, sensitivity of 70%, and a positive predictive value (PPV) of 71%. In protocol 2, from a total of 132 observations (44 for each sign), the sensitivity, specificity, and PPV for a diagnosis of VT were as follows: arterial pulse, 61%, 71%, 70%; JVP, 96%, 75%, 82%; and first heart sound, 58%, 100%, 100%. CONCLUSIONS:It is concluded that, in patients with a regular tachycardia of uncertain origin, clinically detectable variations in the first heart sound and JVP are highly specific and sensitive indicators, respectively, of a diagnosis of VT. Assessment of the arterial pulse is of little value in this role.

journal_name

Circulation

journal_title

Circulation

authors

Garratt CJ,Griffith MJ,Young G,Curzen N,Brecker S,Rickards AF,Camm AJ

doi

10.1161/01.cir.90.6.3103

subject

Has Abstract

pub_date

1994-12-01 00:00:00

pages

3103-7

issue

6

eissn

0009-7322

issn

1524-4539

journal_volume

90

pub_type

临床试验,杂志文章,随机对照试验
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    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

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    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

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    doi:

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