Resetting criteria during ventricular overdrive pacing successfully differentiate orthodromic reentrant tachycardia from atrioventricular nodal reentrant tachycardia despite interobserver disagreement concerning QRS fusion (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.
Pacing and Clinical Electrophysiology, 2015
Background: The stimulus-atrial (SA) interval minus ventriculoatrial (VA) interval (SA-VA) difference represents a simple diagnostic maneuver to distinguish between atrioventricular nodal reentrant tachycardia (AVNRT) and orthodromic reentrant tachycardia (ORT) during electrophysiology study. However, its usefulness has largely been studied in selected patient subgroups. The purpose of this study was to evaluate the performance of the SA-VA difference against commonly used diagnostic maneuvers in a large cohort of consecutive patients. Methods: Consecutive patients with inducible supraventricular tachycardia and successful entrainment through pacing trains from right ventricular apex during an electrophysiological study were included. Atrial tachycardias were excluded. The following intervals were calculated for each patient: SA-VA difference, His potential, and atrial electrogram during entrainment minus His potential and atrial electrogram during tachycardia, and the corrected return cycle.
Journal of the American College of Cardiology, 2010
VA Intervals to Distinguish PSVT. Introduction: Usefulness of the interval between the last pacing stimulus and the last entrained atrial electrogram (SA) minus the tachycardia ventriculoatrial (VA) interval in the differential diagnosis of supraventricular tachycardias with long (>100 ms) VA intervals has not been prospectively studied in a large series of patients. Our objective was to assess the usefulness of the difference SA-VA in diagnosing the mechanism of those tachycardias in patients without preexcitation. The results were compared with those obtained using the corrected return cycle (postpacing interval-tachycardia cycle length-atrioventricular [AV] nodal delay).
Pacing and Clinical Electrophysiology, 1992
We examined entrainment by ventricular pacing in six patients during orthodromic atrioventricular reentrant tachycardia (AVRT) utilizing a left-sided lateral accessory pathway. Constant fusion and progressive fusion were demonstrated in all patients by left ventricular pacing during tachycardia, but in none of the patients by right ventricular pacing. When left ventricular pacing was performed during AVRT, the antidromic wave front from the pacing impulse fn) collided with the orthodromic wave front of the previous pacing beat (n-I] within the ventricle, therefore, constant fusion and progressive fusion were demonstrated in the surface eiectrocardiographic QRS complexes. On the other hand, when right ventricular pacing was performed during orthodromic AVRT, the antidromic wave front from the pacing impulse (n) collided with the orthodromic wave front of the previous paced beat (n-1} within the normal atrioventricular pathway, and constant fusion and progressive fusion were therefore not demonstrated. These phenomena were explained by the relationship of the ventricular pacing site end the reentrant circuit. This study demonstrates the importance of the pacing site in manifest entrainment of orthodromic AVHT during ventricular pacing.
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.
Cardiology, 2014
orthodromic atrioventricular (AV) reentry. Patients with typical AV nodal reentry, atypical AV nodal reentry and atrial tachycardia did not show atrial timing perturbation during fusion complexes of RVOP. Conclusions: Synchronized RVOP from RVIT or RVOT is an easy and accurate method for the quick and reliable differential diagnosis of SVT in various clinical settings, particularly when only a limited number of catheters are used.