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Self-terminating ventricular tachyarrhythmias--a diagnostic dilemma?
R H Clayton1, A Murray, P D Higham
1Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, UK.
Lancet (London, England)
|January 9, 1993
Summary
Self-terminating ventricular tachyarrhythmias are common in coronary care units. Expert cardiologists inconsistently diagnose these events, highlighting subjective interpretations in critical cardiac care.
Area of Science:
- Cardiology
- Electrophysiology
- Critical Care Medicine
Background:
- Ventricular fibrillation is typically lethal without immediate intervention.
- Reports of self-terminating ventricular fibrillation exist but are variably classified by cardiologists as polymorphic ventricular tachycardia or torsade de pointes.
Purpose of the Study:
- To assess how experienced cardiologists diagnose self-terminating ventricular tachyarrhythmias.
- To evaluate the consistency of diagnostic categorisation for these rapid tachyarrhythmias.
Main Methods:
- Electrocardiograms of self-terminating ventricular tachyarrhythmias (rate > 300/min) were sent to 22 cardiologists for diagnosis.
- Patient data from a 19-month coronary care unit monitoring period were analyzed.
Main Results:
- Out of 2462 monitored patients, 45 experienced ventricular fibrillation terminated by DC shock.
- 12 self-terminating tachyarrhythmias were recorded from 8 patients.
- Cardiologists provided 264 diagnoses, with significant variation: 15.9% ventricular fibrillation, 37.5% polymorphic ventricular tachycardia, 37.1% torsade de pointes, and 9.5% other.
- Diagnostic opinions varied significantly among cardiologists (p < 0.01).
Conclusions:
- Rapid self-terminating ventricular tachyarrhythmias are relatively common in coronary care unit patients.
- The diagnostic classification of these events is highly subjective and inconsistent among experienced cardiologists.