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Resetting criteria during ventricular overdrive pacing successfully differentiate orthodromic reentrant tachycardia from atrioventricular nodal reentrant tachycardia despite interobserver disagreement concerning QRS fusion.
MedLine Citation:
PMID:  20933101     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: The beginning of ventricular overdrive pacing (VOP) during supraventricular tachycardia (SVT) accurately distinguishes orthodromic reentrant tachycardia (ORT) from atrioventricular nodal reentrant tachycardia (AVNRT) even when pacing terminates tachycardia. Tachycardia resetting most often occurs during this transition zone (TZ) of QRS fusion in ORT and after this TZ in AVNRT. The end of the TZ is marked by the first beat with a stable QRS morphology but is a subjective assessment. Disagreement concerning this beat may change tachycardia diagnosis.
OBJECTIVE: The purpose of this study was to assess interobserver agreement for identifying the TZ and whether disagreement affected diagnosis.
METHODS: Seventy-nine consecutive patients with inducible ORT and AVNRT were included. Resetting of tachycardia was evaluated by (1) atrial timing perturbation and (2) fixed stimulation-atrial activation timing (SA). Two blinded observers identified the end of the TZ and used the two resetting criteria to establish a diagnosis. Diagnostic results were compared with standard criteria for SVT diagnosis. The diagnosis was considered correct if both electrophysiologists' TZ assessment resulted in a correct diagnosis.
RESULTS: Agreement on the TZ occurred in 80% (148/186) of VOP trains. In ORT patients, tachycardia resetting occurred during the TZ and correctly diagnosed ORT based on atrial timing perturbation and fixed SA in 91% and 98% of VOP trains, respectively. In AVNRT patients, tachycardia resetting occurred after the TZ and correctly diagnosed AVNRT based on atrial timing perturbation and fixed SA in 93% and 94% of VOP trains, respectively.
CONCLUSION: Resetting criteria used during the VOP TZ accurately differentiate between ORT and AVNRT despite interobserver disagreement concerning identification of the TZ.
Authors:
Jonathan Z Rosman; Roy M John; William G Stevenson; Laurence M Epstein; Usha B Tedrow; Bruce A Koplan; Christine M Albert; Gregory F Michaud
Publication Detail:
Type:  Journal Article     Date:  2010-10-07
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  8     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiovascular Medicine at Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.
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