ORIGINAL ARTICLE Diagnostic Accuracy of Several Electrocardiographic Criteria for the Prediction of Atrioventricular Nodal Reentrant Tachycardia Juliana Filgueiras Medeiros, F abio Martins Nardo-Botelho, Lara Cristina Felix-Bernardes, Lucas Hollanda-Oliveira, Lucas Bassolli de Oliveira-Alves, ^ Enia L ucia-Coutinho, Cristiano Dietrich, Adriano Caixeta, Jose Marconi Almeida-de-Sousa, ^ Antonio Carlos-Carvalho, Cl  audio Cirenza, and ^ Angelo Amato Vicenzo-de-Paola Department of Cardiology, Universidade Federal de S~ ao Paulo, UNIFESP, S~ ao Paulo, Brazil Received for publication January 18, 2016; accepted September 13, 2016 (ARCMED-D-16-00032). Background and Aims. Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia (SVT) whose diagnosis can be strongly suspected based on the surface eletrocardiogram alone. The purpose of this study is to determine the diagnostic accuracy of several electrocardiographic (ECG) criteria for the prediction of AVNRT. Methods. Between November 2010 and January 2014, a total of 256 patients who under- went electrophysiological testing (EP) with regular, paroxysmal and narrow QRS com- plex tachycardia were prospectively enrolled. We classified the ECG recordings during tachycardia for the presence of the following criteria: a) classical ECG findings of pseudo S wave in inferior leads and/or pseudo r 0 wave in lead V1, b) notch in lead aVL, c) no retrograde P waves visible during tachycardia; d) pseudo r 0 wave in lead aVR, e) notch in lead D1, f) any deflection after 100 ms of the QRS complex during tachycardia. Results. On multivariate analysis, independent predictors of AVNRT diagnosis were fe- male sex (OR 4.17; 95% CI [2.11e8.24]; p !0.001), age O60 years (OR 3.53; 95% CI [1.25e9.96]; p 5 0.017) and the classical ECG criteria (OR 7.41; 95% CI [3.62e15.17]; p !0.001). Conclusions. Female, age O60 years and the classical ECG criteria were the indepen- dent predictors of AVNRT diagnosis. Although several of the ECG criteria for AVNRT diagnosis showed acceptable sensitivities and specificities, they do not improve its accu- racy. Ó 2016 IMSS. Published by Elsevier Inc. Key Words: Tachyarrhythmia, Tachycardia, Ablation, Atrioventricular nodal reentrant tachycardia. Introduction Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia (SVT) (1e4). Its prevalence increases with age and is higher in women than in men (5,6). A triad of clinical history, physical examination and 12-lead electrocardiogram (ECG) comprises the initial evaluation. The presence of the well-known, classical ECG criteria of pseudo S wave in inferior leads, defined as S wave in infe- rior leads (II, III, aVF) and/or pseudo r 0 wave in lead V1 and the criteria no retrograde P waves visible during tachy- cardia has been widely used for the diagnosis of AVNRT. Although the diagnosis of AVNRT as the mechanism of SVT can be strongly suspected based on the surface ECG alone, several criteria have been proposed to distinguish among the different SVT mechanisms (7e21). These include pseudo S wave in inferior leads, pseudo r 0 wave in lead V1, notch in lead aVL, no retrograde P wave visible during tachycardia, pseudo r 0 wave in lead aVR, notch in Address reprint requests to: Juliana Filgueiras Medeiros, MD, Disci- pline of Cardiology, Universidade Federal de S~ ao Paulo, UNIFESP, Rua Napole~ ao de Barros, 715, CEP: 04024-002, S~ ao Paulo, S~ ao Paulo-SP, Brasil; Phone: (þ55) (11) 55764014; FAX: (þ55) (11) 55764014; E-mail: jumedeiros@terra.com.br . 0188-4409/$ - see front matter. Copyright Ó 2016 IMSS. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.arcmed.2016.09.003 Archives of Medical Research 47 (2016) 394e400