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Atrial Premature Beats During Decrementally Conducting Antidromic Tachycardia.
MedLine Citation:
PMID:  23457113     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -Advancement of ventricular activation by an atrial premature beat (APB) given during His bundle refractoriness, followed by resetting of an antidromic tachycardia (AT) in patients (pts) with decrementally conducting accessory pathway (DAP) is a helpful maneuver to prove pathway existence and participation in the circuit. We aim to assess in a large cohort the role of APB during AT in pts with a DAP. METHODS AND RESULTS: -33 pts with a DAP having 34 AT were included in the study: 29 pts had an atriofascicular pathway, 1 had a long atrioventricular (A-V) DAP and 4 had a short A-V fiber. APBs were delivered initially from the lateral RA, scanning diastole with a 10 ms decrement until AT termination or refractoriness. We observed 4 patterns of response following APB during AT: advancement of activation (29 cases), delay (2), advancement followed by delay (3), and termination (7). Eight pts required an earlier APB in order to advance or delay ventricular activation. These 8 pts had a shorter AT cycle length (median of 273 vs. 315 ms, p= 0,003), and had a shorter resetting zone (median coupling interval of 30 vs. 50 ms, p= 0,01). CONCLUSIONS: -APB delivered during AT in pts with a DAP advanced and/or delayed ventricular activation in all pts. In 1/5 of cases the AT was terminated by a single APB. In approximately a quarter of the patients an earlier coupled APB was needed to reset AT. The high RA was an adequate stimulation site in all right-sided DAP.
Authors:
Eduardo Back Sternick; Yash Lokhandwala; Carl Timmermanns; Luiz Gerken; Frederico Soares; Liana Dias; Yan Huo; Gerhard Hindricks; Hein J J Wellens
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-3-2
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-3-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Biocor Instituto, Nova Lima & Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.
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