Test characteristics of neck fullness and witnessed neck pulsations in the diagnosis of typical AV nodal reentrant tachycardia.

BACKGROUND

Claims in the medical literature suggest that neck fullness and witnessed neck pulsations are useful in the diagnosis of typical AV nodal reentrant tachycardia (AVNRT).

HYPOTHESIS: Neck fullness and witnessed neck pulsations have a high positive predictive value in the diagnosis of typical AVNRT.

METHODS

We performed a cross-sectional study of consecutive patients with palpitations presenting to a single electrophysiology (EP) laboratory over a 1 year period. Each patient underwent a standard questionnaire regarding neck fullness and/or witnessed neck pulsations during their palpitations. The reference standard for diagnosis was determined by electrocardiogram and invasive EP studies.

RESULTS

Comparing typical AVNRT to atrial fibrillation (AF) or atrial flutter (AFL) patients, the proportions with neck fullness and witnessed neck pulsations did not significantly differ: in the best case scenario (using the upper end of the 95% confidence interval (CI), none of the positive or negative predictive values exceeded 79%. After restricting the population to those with supraventricular tachycardia (SVT) other than AF or AFL, neck fullness again exhibited poor test characteristics; however, witnessed neck pulsations exhibited a specificity of 97% (95% CI: 90%-100%) and a positive predictive value of 83% (95% CI: 52%-98%). After adjustment for potential confounders, SVT patients with witnessed neck pulsations had a seven-fold greater odds of having typical AVNRT, p = 0.029.

CONCLUSIONS

Although neither neck fullness nor witnessed neck pulsations are useful in distinguishing typical AVNRT from AF or AFL, witnessed neck pulsations are specific for the presence of typical AVNRT among those with SVT.