Electrophysiological features differentiating the atypical atrioventricular node-dependent long RP supraventricular tachycardias.
Publication/Presentation Date
6-1-2013
Abstract
BACKGROUND: Diagnosing atypical atrioventricular node-dependent long RP supraventricular tachycardias (SVTs) can be challenging.
METHODS AND RESULTS: Nineteen patients with 20 SVTs (atypical atrioventricular nodal reentrant tachycardia without [n=11]/with [n=3] a bystander nodofascicular [NF] accessory pathway, orthodromic reciprocating tachycardia [ORT] using a decremental atrioventricular [permanent form of junctional reciprocating tachycardia; n=4] or NF [NF reentrant tachycardia; n=2]) accessory pathway underwent electrophysiological study. Postpacing interval (PPI)-tachycardia cycle length (TCL), corrected PPI, VA (ventriculoatrial), HA (His-atrial), AH (atrio-His) values, and responses to His-refractory ventricular premature depolarizations were studied. Compared with atrioventricular nodal reentrant tachycardia, ORT patients were younger (42±13 years versus 54±19 years; P=0.036) and were women (5/6 [83%] versus 3/14 [21%]; P=0.036); TCLs were similar (435 ms versus 429 ms; 95% confidence interval, -47.5 to 35.5). PPI-TCL was shorter for ORT (118 ms versus 176 ms; 95% confidence interval, 26.3-89.7) but only 50% had PPI-TCL < 115 ms, whereas 5 of 6 (83%) had PPI-TCL < 125 ms (sensitivity, 83%; specificity, 100%). Corrected PPI < 110 ms, VA < 85 ms, and HA < 0 ms had equivalent sensitivity (67%) and 100% specificity for ORT. Compared with permanent form of junctional reciprocating tachycardia, NF reentrant tachycardia/atrioventricular nodal reentrant tachycardia had longer AH (29 ms versus 10 ms; 95% confidence interval, 3.03-35.0) or AH(SVT)
CONCLUSIONS: This unusual SVT requires separate maneuvers to delineate its upper and lower circuit. Standard entrainment criteria are modestly sensitive but highly specific for ORT; and PPI-TCL of 125 ms seems better than 115 ms. The AH criteria, or paradoxically AH(SVT)
Volume
6
Issue
3
First Page
597
Last Page
605
ISSN
1941-3084
Published In/Presented At
Ho, R. T., Frisch, D. R., Pavri, B. B., Levi, S. A., & Greenspon, A. J. (2013). Electrophysiological features differentiating the atypical atrioventricular node-dependent long RP supraventricular tachycardias. Circulation. Arrhythmia and electrophysiology, 6(3), 597–605. https://doi.org/10.1161/CIRCEP.113.000187
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
23629734
Department(s)
Administration and Leadership
Document Type
Article