Apport de l'étude électrophysiologique par voie transœsophagienne dans le diagnostic étiologique des tachycardies à QRS larges

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Introduction – A wide-QRS complex tachycardia is suggestive of a ventricular tachycardia (VT). Its diagnosis requires an intracardiac electrophysiological study. That study is sometimes difficult to indicate in old or very young patients. The purpose of the study was to evaluate the interest of a rapid and noninvasive study by transesophageal route for the evaluation of the nature of a wide-QRS complex tachycardia. Patients and methods – Forty patients, aged from 16 to 85 years, without bundle branch block (BBB) in sinus rhythm, were admitted for documented wide-QRS tachycardia. Transesophageal electrophysiologic study (EPS) using one and two extrastimuli was performed in control state and after infusion of 20/30 μg of Isoproterenol ®. Intracardiac EPS was performed in a second time in 38 of them. Results – The study was negative six patients; intracardiac EPS remained negative in four of them, induced a VT in one and a Mahaim-reentrant supraventricular tachycardia in another one. Clinical tachycardia was induced in remaining patients: in 27 of them, the diagnosis of SVT with aberrancy was assessed; in other patients, the diagnosis of VT was assessed; The VT was a verapamil-sensitive VT or a bundle branch reentry ( n=7). The diagnosis was confirmed by intracardiac study. Conclusion – Esophageal EPS was a means to reproduce the clinical tachycardia in 34 of 40 patients and to evaluate the mechanism of wide-QRS tachycardia in 33 of 34 patients; this technique easy to perform should be indicated in patients in whom intracardiac study is debatable to avoid to diagnose by excess a VT or in the opposite to miss this diagnosis.