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. 2024 Mar;47(3):383-391.
doi: 10.1111/pace.14946. Epub 2024 Feb 13.

Cannon A wave validation as a diagnostic tool in paroxysmal supraventricular tachycardias

David González-Casal  1 , Alberto Pérez-Castellanos  2 , Nina Soto Flores  1 , Alejandro Carta-Bergaz  3 , Esteban González-Torrecilla  3 , Vanesa Bruña Fernández  4 , Pablo Ávila  3 , Felipe Atienza  3 , Ángel Arenal  3 , Jorge González-Panizo  1 , Francisco Fernández-Avilés  3 , José Angel Cabrera  1   5 , Tomás Datino  1   5
Affiliations

Cannon A wave validation as a diagnostic tool in paroxysmal supraventricular tachycardias

David González-Casal et al. Pacing Clin Electrophysiol. 2024 Mar.

Abstract

Objective: The presence of cannon A waves, the so called "frog sign", has traditionally been considered diagnostic of atrioventricular nodal re-entrant tachycardia (AVNRT). Nevertheless, it has never been systematically evaluated. The aim of this study is to assess the independent diagnostic utility of cannon A waves in the differential diagnosis of supraventricular tachycardias (SVTs).

Methods: We prospectively included 100 patients who underwent an electrophysiology (EP) study for SVT. The right jugular venous pulse was recorded during the study. In 61 patients, invasive central venous pressure (CVP) was registered as well. CVP increase is thought to be related with the timing between atria and ventricle depolarization; two groups were prespecified, the short VA interval tachycardias (including typical AVNRT and atrioventricular reciprocating tachycardia (AVRT) mediated by a septal accessory pathway) and the long VA interval tachycardias (including atypical AVNRT and AVRT mediated by a left free wall accessory pathway).

Results: The relationship between cannon A waves and AVNRT did not reach the statistical significance (OR: 3.01; p = .058); On the other hand, it was clearly associated with the final diagnosis of a short VA interval tachycardia (OR: 10.21; p < .001). CVP increase showed an inversely proportional relationship with the VA interval during tachycardia (b = -.020; p < .001). CVP increase was larger in cases of AVNRT (4.0 mmHg vs. 1.2 mmHg; p < .001) and short VA interval tachycardias (3.9 mmHg vs. 1.2 mmHg; p < .001).

Conclusion: The presence of cannon A waves is associated with the final diagnosis of short VA interval tachycardias.

Keywords: cardiac physiology; electrophysiology; frog sign; jugular pulse; physical examination.

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References

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