Utility of the aVL lead in the electrocardiographic diagnosis of atrioventricular node re-entrant tachycardia
Bibliographic record
Abstract
AIMS: Reciprocating atrioventricular tachycardia can be categorized into common slow-fast atrioventricular node re-entrant (AVNRT) and orthodromic atrioventricular reciprocating tachycardia (AVRT). The electrocardiogram (ECG) during tachycardia is useful in distinguishing these two mechanisms. The presence of a pseudo-R'-wave in lead V1 or pseudo-S-wave in the inferior leads has been widely used, although the value of an isolated aVL lead has not been evaluated yet. To determine whether an isolated aVL lead of the surface 12-lead ECG is useful for the differential diagnosis between AVNRT and AVRT. METHODS AND RESULTS: Consecutive patients referred for paroxysmal regular supraventricular tachycardia radiofrequency ablation were prospectively evaluated. Patients with atrial tachycardia, bundle branch block, manifested pre-excitation, and those undiagnosed after electrophysiology study were excluded. We compared the standard criteria with the value of an isolated aVL lead to distinguish between AVNRT and AVRT. One hundred and one patients were included; 73.3% were AVNRT and 26.7% AVRT. Patients with AVNRT were older (49.4 +/- 16.4 vs. 36.0 +/- 18.7 years, P = 0.001). The aVL notch and the standard criteria were found more frequently in AVNRT than in AVRT (aVL notch: 51.3 vs. 7.4%, P< or = 0.001; pseudo-S-wave 45 vs. 8.6% P = 0.001; and pseudo-R'-wave in V1 39.7 vs. 11.5%, P = 0.008, respectively). The aVL notch sensitivity and specificity to determine the final diagnosis were higher than the standard criteria (aVL notch 48.6 and 92.6%; pseudo-S-wave 45 and 91.3%; and pseudo-R'-wave in V1 39.7 and 88.5%, respectively). CONCLUSION: The presence of a notch in aVL lead appeared to be as sensitive and specific as the standard electrocardiographic criteria for the differential diagnosis of AVNRT.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".