Document Detail

A novel approach to differentiating orthodromic reciprocating tachycardia from atrioventricular nodal reentrant tachycardia.
MedLine Citation:
PMID:  20638932     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Various diagnostic maneuvers have been proposed to help differentiate orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentrant tachycardia (AVNRT) prior to ablation. However, not all criteria are applicable in every situation as each has limitations.
OBJECTIVE: The purpose of this study was to determine whether the behavior of tachycardia during onset of right ventricular (RV) pacing would help differentiate ORT from AVNRT.
METHODS: We retrospectively reviewed 72 cases (42 typical AVNRT, 7 atypical AVNRT, 15 left free-wall pathways, 6 septal pathways, 2 right free-wall pathways). We assessed the number of beats required to accelerate the tachycardia cycle length (TCL) to the paced cycle length (PCL) once a fully RV paced complex was achieved during supraventricular tachycardia.
RESULTS: In the AVNRT group, delta cycle length (DCL = PCL-TCL) was 29 +/- 16 ms compared to 29 +/- 10 ms in ORT group (P = NS). In the AVNRT group, the average number of fully RV paced beats required to reset the tachycardia was 3.7 +/- 1.1 compared to 1 +/- 0 in the ORT group (P <.0001). Using a cutoff >1 beat yielded both positive and negative predictive values of 100% for diagnosing AVNRT versus ORT. During entrainment attempts, AVNRT terminated 51% of the time and ORT terminated 65% of the time but still allowed application of the new criterion.
CONCLUSION: Assessing timing and type of response of supraventricular tachycardia to RV pacing can help differentiate ORT from AVNRT with high certainty and prevent the need for other pacing maneuvers and measurements.
Gopi Dandamudi; Rasoul Mokabberi; Chafik Assal; Mithilesh K Das; Jess Oren; Randle Storm; Pugazhendhi Vijayaraman; John M Miller
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-05-31
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  7     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-31     Completed Date:  2011-01-25     Revised Date:  2013-01-18    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1326-9     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Geisinger Heart Institute, Danville/Wilkes-Barre, Pennsylvania, USA.
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MeSH Terms
Cardiac Pacing, Artificial / methods
Diagnosis, Differential
Electrophysiologic Techniques, Cardiac / methods*
Follow-Up Studies
Heart Conduction System / physiopathology*
Heart Rate / physiology*
Middle Aged
Retrospective Studies
Tachycardia, Atrioventricular Nodal Reentry / diagnosis*,  physiopathology,  therapy
Tachycardia, Reciprocating / diagnosis*,  physiopathology,  therapy
Time Factors
Comment In:
Heart Rhythm. 2011 Feb;8(2):e2; author reply e2-3   [PMID:  21109024 ]
Heart Rhythm. 2011 Mar;8(3):e9; author reply e9   [PMID:  21185949 ]
Heart Rhythm. 2012 Dec;9(12):e27; author reply e27-8   [PMID:  21215820 ]

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