Author + information
- Received October 30, 2017
- Revision received January 16, 2018
- Accepted January 31, 2018
- Published online March 28, 2018.
- Hiroyuki Ito, MDa,∗ (, )
- Nitish Badhwar, MDb,
- Akash R. Patel, MDc,
- Kurt S. Hoffmayer, MD, PharmDd,
- Joshua D. Moss, MDb,
- Cara N. Pellegrini, MDb,e,
- Vasanth Vedantham, MD, PhDb,
- Zian H. Tseng, MDb,
- Ronn E. Tanel, MDc,
- Henry H. Hsia, MDb,e,
- Randall J. Lee, MD, PhDb,
- Gregory M. Marcus, MD, MASb,
- Edward P. Gerstenfeld, MDb and
- Melvin M. Scheinman, MDb
- aDivision of Cardiology, Department of Medicine, Showa University, Tokyo, Japan
- bSection of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California
- cDivision of Pediatric Cardiology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
- dSection of Electrophysiology, Division of Cardiology, University of California, San Diego, San Diego, California
- eSan Francisco VA Medical Center, San Francisco, California
- ↵∗Address for correspondence:
Dr. Hiroyuki Ito, Division of Cardiology, Department of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan 142-8666.
Objectives This study hypothesized that early coupled ventricular extrastimuli (V2) stimulation might yield a more robust differentiation between atrioventricular nodal re-entrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT).
Background Programmed V2 during supraventricular tachycardia are useful to differentiate AVNRT from AVRT by subtracting the ventriculoatrial (VA) interval from the stimulus to atrial depolarization (stimulus atrial [SA]) interval, but all such maneuvers have limitations.
Methods Patients with either AVNRT or AVRT were investigated. The entire tachycardia cycle length (TCL) was scanned with V2 delivered from the right ventricular apex. The SA−VA difference was calculated with V2 clearly resetting the tachycardia. The prematurity of V2 was calculated by dividing the coupling interval (CI) by the TCL.
Results A total of 210 patients (102 with AVNRT) were included. The SA−VA difference was >70 ms in all AVNRT patients and was <70 ms in all AVRT patients with right and septal accessory pathways (APs), except for those with decremental APs, in whom there was an overlap between AVNRT and AVRT with left APs. However, a SA−VA difference >110 ms with a CI/TCL of <65% distinguished AVNRT from AVRT using the left AP, with sensitivity and specificity of 87% and 100%, respectively. Ventricular overdrive pacing resulted in tachycardia termination or AV dissociation in 28% of patients compared with 15% of patients using the V2 technique (p = 0.008).
Conclusions A SA−VA of >70 ms using the V2 technique differentiated AVNRT from AVRT using septal and right APs. Use of the V2 technique with a short CI differentiated AVNRT from AVRT using left APs. The V2 technique less frequently resulted in tachycardia termination compared with ventricular entrainment.
- coupling interval
- premature ventricular extrastimulus
- supraventricular tachycardia
- ventricular entrainment
- ventriculoatrial interval
Dr. Pellegrini has been a consultant for Abbott. Dr. Hsia has been a member of the speakers bureau for Biosense Webster; a member of the Advisory Board for Medtronic; and a consultant for Vytronus. Dr. Scheinman has received honoraria from St. Jude Medical, Medtronic, Biosense Webster, and Biotronik. All other 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 October 30, 2017.
- Revision received January 16, 2018.
- Accepted January 31, 2018.
- 2018 American College of Cardiology Foundation
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