Simplified Automated Right Ventricular Overdrive Pacing for Rapid Diagnosis of Supraventricular Tachycardia (original) (raw)
Related papers
Heart Rhythm, 2014
Background: Because the His bundle is intrinsic to the circuit in ORT and remote from that of AVNRT, pacing the His bundle during supraventricular tachycardia (SVT) may be useful to distinguish these arrhythmias. Objective: We tested the hypothesis that His Overdrive Pacing (HOP) would affect SVT immediately for ORT and in a delayed manner for AVNRT. Methods: Once SVT was induced, HOP was performed by pacing the His bundle 10-30 ms faster than the SVT cycle length. The maneuver was determined to have entered the tachycardia circuit when a non-fused his-capture beat advanced or delayed the subsequent atrial electrogram by ≥ 10 ms or when the tachycardia was terminated. The number of beats required to enter each tachycardia with HOP was recorded. Results: HOP was performed during 66 SVT's (26 AVRT and 40 AVNRT). Entry into the tachycardia within 1 beat had a sensitivity of 92%, specificity of 92%, positive predictive value (PPV) of 89% and a negative predictive value (NPV) of 95% to confirm the diagnosis of AVRT. A cutoff of ≥ 3 beats to enter the circuit had a sensitivity of 90%, Specificity of 92%, PPV of 95% and NPV of 86% to confirm the diagnosis of AVNRT. HOP had a sensitivity, specificity, PPV and NPV of 100% for distinguishing septal AVRT from atypical AVNRT. Conclusions: HOP during SVT is a novel technique for distinguishing ORT from AVNRT. It can reliably distinguish between these arrhythmias with high sensitivity and specificity.
Diagnostic Pacing Maneuvers for Supraventricular Tachycardia: Part 1
This two-part manuscript reviews diagnostic pacing maneuvers for supraventricular tachycardia (SVT). Part one will involve a detailed consideration of ventricular overdrive pacing (VOP), since this pacing maneuver provides the diagnosis in the majority of cases. This will include a review of the post-VOP response, fusion during entrainment, the importance of the VOP site, quantitative results of entrainment such as the postpacing interval, differential entrainment, and new criteria derived from features found at the beginning of the VOP train. There is a considerable literature on this topic, and this review is by no means meant to be all-encompassing. Rather, we hope to clearly explain and illustrate the physiology, strengths, and weaknesses of what we consider to be the most important and commonly employed diagnostic pacing maneuvers, that is, those that trainees in cardiac electrophysiology should be well familiar with at a minimum. (PACE 2011; 34:767–782)
Diagnostic pacing maneuvers for supraventricular tachycardias - Part 2
The approach to supraventricular tachycardia (SVT) diagnosis can be complex because it involves synthesizing baseline electrophysiologic features, features of the SVT, and the response(s) to pacing maneuvers. In this two-part review, we will mainly explore the latter while recognizing that neither of the former can be ignored, for they provide the context in which diagnostic pacing maneuvers must be correctly chosen and interpreted. Part 1 involved a detailed consideration of ventricular overdrive pacing, since this pacing maneuver provides the diagnosis in the majority of cases. In Part 2, other diagnostic pacing maneuvers that might be helpful when ventricular overdrive pacing is not diagnostic or appropriate, including attempts to reset SVT with single atrial or ventricular beats, para-Hisian pacing, apex versus base pacing, and atrial overdrive pacing, are discussed, as are some specific diagnostic SVT challenges encountered in the electrophysiology lab. There is considerable literature on this topic, and this review is by no means meant to be all-encompassing. Rather, we hope to clearly explain and illustrate the physiology, strengths, and weaknesses of what we consider to be the most important and commonly employed diagnostic pacing maneuvers, that is, those that trainees in cardiac electrophysiology should be well familiar with at a minimum. (PACE 2012; 35:757-769)
Journal of Atrial Fibrillation, 2017
Introduction: Failure to differentiate supraventricular from ventricular arrhythmias is the most frequent cause of inappropriate implantable cardioverter-defibrillator (ICD) therapies. We hypothesized that the postpacing interval (PPI) after overdrive right ventricular pacing may differentiate ventricular (VT) from supraventricular tachycardia (SVT) such as sinus tachycardia, atrial flutter and atrial tachycardia. This hypothesis is based on the entrainment maneuver. Reentrant tachycardia circuit for VTs would haveshorter distance to RV apex than SVTs have, and the conduction time between a ventricular pacing site and the tachycardia origin is expected to be shorter in VTs than in SVTs. Methods: 220episodes from 38 patients with single chamber ICDs that RV overdrive pacing could not terminate or change the tachycardia cycle length (TCL) were retrospectively reviewed. Episodes were classified as VTs (n=115) and SVTs (n=105). TCLs, PPIs and PPI-TCL were compared between groups. Results: The cycle length of VTs was shorter than SVTs (320.6±30.3 vs 366.5±40 ms, p=0.001). PPI and PPI-TCL of VTs were shorter than SVTs (504.7±128.3 vs 689.2±121.8 ms, p=0.001, 184±103 vs 322.6±106.6 ms, p=0.001; respectively). ROC curve analysis demonstrated a 525 ms cutoff value for PPI has 89% sensitivity and 57.4% specificity to predict inappropriate ICD therapies due to SVTs (AUC:0.852). Similarly, A PPI-TCL <195 ms favored VT as a diagnosis rather than SVT with a 90% sensitivity, and 51% specificity (AUC:0.838). Conclusions: Analyzing of PPI during overdrive pacing from RV apex may discriminate supraventricular from ventricular tachycardia. This criterion may have a potential role in implantable devices that use a single ventricular lead.
A novel pacing manoeuvre to diagnose atrial tachycardia
Europace, 2008
Aims Currently used diagnostic manoeuvres at the electrophysiology study do not always allow for consistent identification of atrial tachycardia (AT), either because of inapplicability of the technique or because of low predictive value and specificity. The aim of this study was to determine whether overdrive atrial pacing during paroxysmal supraventricular tachycardia (SVT) with the same cycle length from both the high right atrium and the coronary sinus can accurately identify or exclude AT by examining the difference between the V-A intervals of the first returning beat of tachycardia between the two pacing sites. Methods and results Fifty-two patients were included; 24 patients with atrioventricular nodal re-entry tachycardia (AVNRT), 13 patients with atrioventricular re-entry tachycardia (AVRT), and 15 patients with AT. Comparing the 37 non-AT patients with the 15 AT patients, there was a highly significant difference between the mean V-A interval difference, (delta V-A) 2.1 + 1.8 ms (range 0-9 ms) vs. 79.1 + 42 (range 22-267 ms) (P , 0.001), respectively. None of the patients in the non-AT group had a delta V-A . 10 ms. In contrast, all 15 patients with AT had a delta V-A interval .10 ms. Thus, the diagnostic accuracy of the delta V-A interval cut-off of .10 ms was 100%, with a 95% confidence interval of 93.1-100% for AT. In 11 (73%) of the 15 AT patients, the standard ventricular overdrive pacing manoeuvre was not possible. In 14 of the 15 patients (93%) in the AT group, standard atrial overdrive pacing showed variable V-A intervals, correctly diagnosing AT. In all 52 patients, this measurement was repeated during pacing from the other location. In five patients from the AT group, the result of the second attempt was different from the result of the first attempt. Conclusion We found that atrial differential pacing during paroxysmal SVT without termination of tachycardia and the finding of variable returning V-A interval was highly sensitive and specific for the diagnosis of AT. The manoeuvre can be easily performed in all patients with SVT and is highly reproducible. It is a useful adjunct to the currently available ventricular and atrial pacing manoeuvres.
American Journal of Cardiology, 1984
( AV) nodal reentrant tachycardia. Entrainment could be performed while pacing from the high right atrium in 35 of 35 episodes, from proximal coronary sinus in 9 of 21 episodes and from distal coronary sinus in 10 of 20 episodes. The minimal rates required were 8 to 40 beats/min faster than those of the tachycardias. That the atria (as defined in electrophysiologic studies) were not a necessary component of the reentry circuit was suggested by the occurrence, during tachycardia, of short episodes of AV dissociation and of 1 episode of 2:l retrograde block. For the tachycardia to be interrupted, the pacing rate usually had to be slightly faster than that required to entrain, as well as sufficiently rapid to produce anterograde block of an atrial impulse in the slow AV nodal pathway. Moreover, termination of tachycardia apparently was a function of the pacing site. In some episodes, either because of a proximity effect or because of a preferential input into the upper common pathway, coronary sinus pacing terminated the tachycardia at slower rates or with fewer stimuli than high right atrial pacing. Thus, patients with drug-resistant AV nodal reentrant tachycardias may benefit from recently introduced pacing techniques for termination of tachycardia through entrainment.
Long-Term Results of Antitachycardia Pacing in Patients with Supraventricular Tachycardia
Pacing and Clinical Electrophysiology, 1989
Results of Antitachycardia Pacing in Patients with Supraventricular Tachycardia. Between 1979 and 1984 the Cybertach-60, {Intermedics, Inc. Model 262-01}, a programmable, automatic antitachycardia pacemaker was implanted in 31 patients who had drug-re/ractory supraventricular tachycardia (SVTJ. The patients have been followed for a total of 64-108 (mean 84 months). All patients were symptomatic and had /ailed two or more drugs and six patients had required prior DC cardioversion. The mechanism o/supraventricuJar tachycardia was atrioventricular (AV) nodal reentry in six patients, AV reentry in four patients, and atrial tachycardia in one patient. Preoperatively all patients had reJiable termination of the tachycardia without induction of atrial jibriliation by pacing methods available to Cybertach-60. Postimplant, Cybertach-60 reliably terminated all episodes o/tachycardia without ancillary drug therapy. Nevertheless, at iong-term foUow-up antitachycardia pacing was effective and safe in the minority (36%}. with only four patients out of eleven still using a pacemaker for supraventricu/ar tachycardia. One of these four patients required additional drug therapy. In one of the patients, the Cyhertach-60 was replaced after 78 months by a more advanced device, (Intertach, Intermedics, Inc.) because of a depleted Cybertach-60 battery. In seven patients who no longer use antitachycardia pacing for termination of tachycardia, one patient developed atrial jibrilJation during tachycardia termination (at 58 months postimplant). Three patients experienced induction of tachycardia or atrial ^briiiation by the pacemaker due to undersensing of sinus P waves (at 36, 48, and 51 months}. One patient had inappropriate rate detection while in sinus rhythm triggering the tachycardia termination burst from the pacemaker and subsequent SVT induction. Although pace termination of supraventricuJar tachycardia was effective in two patients, they chose elective ablation (AV nodal and accessory pathway, respectively, at 74 and 6 months) due to frequent symptomatic SVT. (PACE, VoJ. 12, fune 1989} antitachycardia pacing, supraventricular tachycardia Address for reprints: Ingela Schntttger, M.D., Cardiology Divi-i r L i sion.
Introduction to Supraventricular Tachycardia
Cardiac Electrophysiology Clinics, 2010
Paroxysmal supraventricular tachycardia (PSVT) is a clinical syndrome characterized by a rapid tachycardia with an abrupt onset and termination. These arrhythmias are frequently encountered in otherwise healthy patients without structural heart disease. Symptoms vary from palpitations and dyspnea to tachycardia-induced cardiomyopathy. The three most common causes of PSVT are atrioventricular nodal reentrant tachycardia (AVNRT) (50%-60%), atrioventricular reentrant tachycardia (AVRT) in patients with Wolff-Parkinson-White syndrome (25%-30%), and atrial tachycardia (10%). Rare causes of PSVT include focal junctional tachycardia, atriofascicular tachycardia, permanent reciprocating junctional tachycardia, and nodoventricular/nodofascicular tachycardia. This section, based on challenging PSVT cases, is a guide for clinicians dealing with diagnostic or therapeutic dilemmas in the electrophysiology laboratory.