Document Detail

Tachycardia induction with ventricular extra-stimuli differentiates atypical atrio-ventricular nodal re-entrant tachycardia from orthodromic reciprocating tachycardia.
MedLine Citation:
PMID:  22001824     Owner:  NLM     Status:  Publisher    
BACKGROUND: Differentiating atypical atrio-ventricular re-entrant tachycardia (AVNRT) from septal orthodromic re-entrant tachycardia (ORT(Septal)) is challenging in non-sustained tachycardia. When sustained, the post-pacing interval minus tachycardia cycle length following entrainment (PPI(Entrainment)-TCL) and stimulation to atrial interval minus ventriculoatrial interval (Stim-A(Entrainment)-VA) is utilized. OBJECTIVE: We hypothesized that the first tachycardia cycle after tachycardia induction with right ventricular apical (RVA) extra stimulation would yield comparable information to entrainment, precluding the need for sustained tachycardia. METHODS: Twenty-four patients with AVNRT (age 47±18), 19 with ORT(Septal) (age 42±17) and 15 with ORT over a left lateral accessory pathway (ORT(Left)) (age 41±16) were included. The ventricular extra stimulus to atrial depolarization at tachycardia initiation (Stim-A(Initiation)) and tachycardia VA interval was measured to establish the Stim-A(Initiation) minus VA interval (Stim-A (Initiation–)VA). The ventricular extra stimulus to the subsequent RVA depolarization (Post Pacing Interval at Initiation, PPI(Initiation)) was utilized to obtain the PPI(Initiation) minus TCL (PPI(Initiation)-TCL). The AH interval associated with the PPI(Initiation) minus the AH in tachycardia was utilized to establish a corrected PPI(Initiation)-TCL (cPPI(Initiation)-TCL). RESULTS: The intervals after tachycardia initiation were longer for AVNRT than ORT: mean PPI (Initiation–)TCL (193±44 vs. 91±73, p<0.001), cPPI(Initiation)-TCL (174±44ms vs. 88±50ms, p<0.001) and Stim-A (Initiation–)VA (161±45ms vs. 69±53ms, p<0.001). The correlation coefficient for Stim-A(Initiation)-VA against Stim-A(Entrainment)-VA was 0.79 and cPPI(Initiation)-TCL against PPI(Entrainment)-TCL was 0.71. The cPPI(Initiation)-TCL <115ms or Stim-A (Initiation–)VA <85ms was only observed in ORT. The converse was observed in AVNRT but also in ORT(Septal) over decremental APs and ORT(Left). CONCLUSION: Stim-A (Initiation-)VA <85ms or cPPI(Initiation)-TCL <115ms excludes AVNRT.
Manoj Obeyesekere; Lorne J Gula; Simon Modi; Peter Leong-Sit; Paul Angaran; Alexis Mechulan; Allan C Skanes; Andrew D Krahn; Raymond Yee; George J Klein
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-12
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011. Published by Elsevier Inc.
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