Author + information
- Received February 9, 2017
- Revision received May 8, 2017
- Accepted May 30, 2017
- Published online November 20, 2017.
- Mitsunori Maruyama, MD, PhDa,∗ (, )
- Shunsuke Uetake, MD, PhDa,
- Yasushi Miyauchi, MD, PhDa,
- Yoshihiko Seino, MD, PhDa and
- Wataru Shimizu, MD, PhDb
- aDepartment of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
- bDepartment of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
- ↵∗Address for correspondence:
Dr. Mitsunori Maruyama, Department of Cardiovascular Medicine, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamakari, Inzai-city, Chiba 2701694, Japan.
Objectives The goal of this study was to determine the diagnostic yield of analyzing the mode of termination during ventricular overdrive pacing (VOP) to differentiate the mechanisms of supraventricular tachycardias (SVTs).
Background The majority of the diagnostic criteria for VOP rely on successful entrainment, but termination of SVTs is common during VOP.
Methods We studied 225 SVTs with a 1:1 atrioventricular relationship, including 34 atrial tachycardias, 67 orthodromic reciprocating tachycardias (ORTs) (including 4 ORTs using accessory pathways [APs] with decremental properties), and 124 atrioventricular nodal re-entrant tachycardias. The total pacing prematurity (TPP) needed to reset or terminate the SVT was calculated by using a simplified method, and the post-pacing interval minus the tachycardia cycle length (PPI – TCL) was predicted from the TPP.
Results VOP terminated 87 SVTs (39%). No atrial tachycardias were terminated by VOP in this study. SVT termination occurred after (n = 71) or before (n = 16) atrial resetting. The predicted PPI – TCL was highly correlated with the measured PPI – TCL (r = 0.96; p < 0.001). The TPP had diagnostic accuracy equivalent to the predicted PPI – TCL. The TPP was measurable irrespective of the termination mode and correctly diagnosed ORTs with decremental APs. All ORTs using septal APs and no atrioventricular nodal re-entrant tachycardias had a TPP <125 ms. Considering other criteria evaluable in terminated SVTs, a combined criteria of a TPP <125 ms and atrial capture/termination within the fusion period were specific for ORTs using free-wall APs, except for left anterolateral/lateral sites.
Conclusions The termination analyses were useful for differential diagnoses of SVTs terminated during VOP.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 9, 2017.
- Revision received May 8, 2017.
- Accepted May 30, 2017.
- 2017 American College of Cardiology Foundation