Investigation of clinical significance of ST-segment depression during paroxysmal supraventricular tachycardia

Yuanyuan Cao; Zhihong Wu; Zhenjiang Liu; Qiming Liu; Shenghua Zhou

doi:10.1016/j.jelectrocard.2024.02.009

Investigation of clinical significance of ST-segment depression during paroxysmal supraventricular tachycardia

J Electrocardiol. 2024 Mar 5:84:52-57. doi: 10.1016/j.jelectrocard.2024.02.009. Online ahead of print.

Authors

Yuanyuan Cao¹, Zhihong Wu¹, Zhenjiang Liu¹, Qiming Liu², Shenghua Zhou¹

Affiliations

¹ Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
² Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China. Electronic address: qimingliu@csu.edu.cn.

PMID: 38518582
DOI: 10.1016/j.jelectrocard.2024.02.009

Abstract

Introduction: There are great differences in ST-segment depression during PSVT episodes. The aim of this study is to investigate the clinical significance of ST segment depression during PSVT.

Methods: The study enrolled 333 consecutive patients who were diagnosed with PSVT by electrophysiological test from Jan 1, 2021 to July 31, 2022. The range, magnitude and morphology of ST-segment depression were described. The correlation between ST-segment depression and symptoms of chest tightness, chest pain or hypotension, the correlation between ST-segment depression and coronary stenosis, and the possible influencing factors were analyzed. In addition, the diagnostic efficacy of ST-segment depression for AVRT was determined.

Results: ST-segment depression was present in 85% of patients, in 70% of which the depression range was more than six leads. The magnitude of the depression was more significant in precordial leads (P < 0.001). ST-segment depression of >1 mm in limb leads and precordial leads was found in 36.0% and 49.8% of the patients, respectively, while >3 mm was found in 2.4% and 9.6%, respectively. The morphology of ST-segment depression in limb leads was different from that in precordial leads (P < 0.001). Downsloping ST-segment depression was more common in limb leads (limb vs. precordial: 40.5% vs. 12.6%), whereas upsloping depression was more common in precordial leads (limb vs. precordial: 3.0% vs. 23.1%). Correlation analysis showed that ST-segment depression was not correlated with symptoms of chest tightness and pain, nor was it correlated with coronary artery stenosis. The most important influencing factor is the type of PSVT, especially affecting the morphology of depression in limb leads (OR = 10.27 [5.93-17.79], P < 0.001). The sensitivity and specificity of downsloping ST-segment depression in limb leads for diagnosis of AVRT were 75.5% and 76.7%.

Conclusion: ST-segment depression is a common ECG change during PSVT episodes, and it's not associated with severe coronary stenosis. The type of PSVT has a significant effect on the manifestation of ST-segment depression. The downslope morphology of ST-segment depression in limb leads is helpful in differentiating AVRT from AVNRT.

Keywords: Atrioventricular reciprocating tachycardia; Myocardial ischemia; Paroxysmal supraventricular tachycardia; ST-segment depression.