A technique for the rapid diagnosis of atrial tachycardia in the electrophysiology laboratory

Knight, Bradley P.; Zivin, Adam; Souza, Joseph J.; Flemming, Matthew; Pelosi, Frank; Goyal, Rajiva; Man, K. Ching; Strickberger, S. Adam; Morady, Fred

doi:10.1016/s0735-1097(98)00614-7

Cited by 256 publications

(171 citation statements)

References 13 publications

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“…13,21 Furthermore, the V-A-V response observed in our patients confirmed that the FP and the superior SP are the anterograde and retrograde limbs, respectively, of the sup-F/S-AVNRT.…”

Section: Diagnosis Of Avnrtsupporting

confidence: 82%

“…Moreover, a diagnosis of orthodromic atrioventricular reentrant tachycardia incorporating a slowly conducting atrioventricular or nodoventricular accessory pathway 7 as the retrograde limb was excluded by 1 or all of the following observations: inability to modify or entrain the tachycardia by ventricular overdrive pacing, that is, the presence of ventriculoatrial dissociation during ventricular overdrive pacing of the tachycardia 8,9 (overdrive pacing criterion); development of second-degree atrioventricular block during ongoing tachycardia 10 ; or a shorter stimulus-to-atrial electrogram interval during entrainment pacing from the RV apex than from the RV base (differential entrainment pacing). 11 The diagnosis of atrial tachycardia was excluded by 1 or both of the following observations: termination of the tachycardia by ventricular pacing without atrial capture 12 or a V-A-V activation sequence after ventricular induction/reinitiation of the tachycardia resulting from retrograde conduction over the superior SP followed by anterograde conduction over the FP, 13 including dual atrial responses (DARs) from simultaneous retrograde conduction over the FP and superior SP after the last ventricular stimulus. A DAR was diagnosed as a V-A-A-V activation sequence with an A-A interval shorter than the subsequent tachycardia cycle length and both earliest atrial activations in the HB region.…”

Section: Electrophysiological Studymentioning

confidence: 99%

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Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Incorporating a “Superior” Slow Pathway

et al. 2016

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Background— The existence of an atypical fast-slow (F/S) atrioventricular nodal reentrant tachycardia (AVNRT) including a superior (sup) pathway with slow conductive properties and an atrial exit near the His bundle has not been confirmed. Methods and Results— We studied 6 women and 2 men (age, 74±7 years) with sup-F/S-AVNRT who underwent successful radiofrequency ablation near the His bundle. Programmed ventricular stimulation induced retrograde conduction over a superior SP with an earliest atrial activation near the His bundle, a mean shortest spike-atrial interval of 378±119 milliseconds, and decremental properties in all patients. sup-F/S-AVNRT was characterized by a long-RP interval; a retrograde atrial activation sequence during tachycardia identical to that over a sup-SP during ventricular pacing; ventriculoatrial dissociation during ventricular overdrive pacing of the tachycardia in 5 patients or atrioventricular block occurring during tachycardia in 3 patients, excluding atrioventricular reentrant tachycardia; termination of the tachycardia by ATP; and a V-A-V activation sequence immediately after ventricular induction or entrainment of the tachycardia, including dual atrial responses in 2 patients. Elimination or modification of retrograde conduction over the sup-SP by ablation near the right perinodal region or from the noncoronary cusp of Valsalva eliminated and confirmed the diagnosis of AVNRT in 4 patients each. Conclusions— sup-F/S-AVNRT is a distinct supraventricular tachycardia, incorporating an SP located above the Koch triangle as the retrograde limb, that can be eliminated by radiofrequency ablation.

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“…13,21 Furthermore, the V-A-V response observed in our patients confirmed that the FP and the superior SP are the anterograde and retrograde limbs, respectively, of the sup-F/S-AVNRT.…”

Section: Diagnosis Of Avnrtsupporting

confidence: 82%

Section: Electrophysiological Studymentioning

confidence: 99%

Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Incorporating a “Superior” Slow Pathway

et al. 2016

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“…AV block during ongoing tachycardia was consistent with anterograde block at the level of the lower common pathway. 6,7) Although a V-A-A-V response following ventricular pacing is generally diagnostic of atrial tachycardia, 8) in this case it was due to a dual atrial response to simultaneous retrograde conduction over a fast and a slow AV nodal pathway, followed by initiation of a fast-slow AVNRT, which was confi rmed by ventricular pacing (Figure 1). …”

Section: Case Reportmentioning

confidence: 79%

Successful Ablation of Atypical Atrioventricular Nodal Reentrant Tachycardia From a Noncoronary Sinus of Valsalva

et al. 2014

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SummaryAn 81-year-old man with long RP narrow QRS tachycardia underwent catheter ablation. Ventricular pacing reset the atrial cycle over a retrograde slow pathway, followed by termination of the tachycardia without atrial capture, confi rming the diagnosis of fast-slow atrioventricular nodal reentrant tachycardia (AVNRT). The earliest atrial activation during tachycardia was found in the noncoronary sinus of Valsalva, where the fi rst delivery of radiofrequency energy terminated and eliminated the inducibility of the tachycardia, by retrograde conduction block over the slow pathway. This is the fi rst report of a fast-slow AVNRT, with successful ablation of the slow pathway from a noncoronary sinus of Valsalva. (Int Heart J 2014; 55: 84-86) Key words: Supraventricular tachycardia, Atrioventricular nodal tachycardia, Slow pathway ablation, Noncoronary cusp S low pathway ablation is a curative treatment for atrioventricular (AV) nodal reentrant tachycardia (NRT), and is usually performed with lesions created in the inferior or mid segment of the triangle of Koch.1-3) We describe a rare, atypical AVNRT successfully treated by ablation of a slow pathway from a noncoronary aortic cusp. Case ReportAn 81-year-old man who had a history of multiple episodes of paroxysmal supraventricular tachycardia underwent electrophysiologic studies and a catheter ablation procedure. A 12-lead electrocardiogram during tachycardia showed a long RP tachycardia with biphasic P waves in leads II, III, and aVF. Atrial extrastimulation elicited no dual anterograde AV nodal conduction. Decremental ventriculoatrial conduction and maximum 1:1 conduction at a rate of 110 ppm were observed, with the earliest atrial activation site in the bundle of His region, consistent with retrograde AV nodal conduction (Figure 1). A narrow QRS tachycardia documented previously was reproducibly induced by atrial extrastimulation at a coupling interval of 400 ms to 290 ms and ventricular overdrive pacing (Figure 1). During tachycardia with stable 1:1 AV conduction, the earliest atrial activation was recorded at the bundle of His, as was observed during ventricular overdrive pacing. Retrograde VA conduction could not be evaluated by ventricular extrastimulus due to incessant tachycardia easily induced by ventricular basic stimulation. Wenckebach periodicity with a similar atrial activation sequence was also frequently observed during ongoing tachycardia, excluding the diagnosis of AV reentrant tachycardia. A 4-mg bolus injection of adenosine triphosphate (ATP) reproducibly terminated the tachycardia after a last ventricular event, following incremental prolongation of the atrial cycle length. Ventricular extrastimuli delivered during the tachycardia did not reset the atrial cycle, though ventricular overdrive pacing at a cycle length slightly shorter than that of the tachycardia reset the atrial cycles and terminated the tachycardia (Figure 2). Presuming the presence of dual AV nodal conduction, the electrophysiological observations shown in Figure 2 are exp...

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“…Diagnoses of AVNRT or ORT through a concealed AP were made according to conventional electrophysiological criteria. 6,7) Atrial tachycardia was excluded in all patients by the presence of an atrial-ventricular response after entrainment of the tachycardia from RV. 7) Entrainment of the tachycardia was attempted by 5 to 10 pacing pulses from RV at a cycle length 20 to 40 ms shorter than the tachycardia cycle length.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…6,7) Atrial tachycardia was excluded in all patients by the presence of an atrial-ventricular response after entrainment of the tachycardia from RV. 7) Entrainment of the tachycardia was attempted by 5 to 10 pacing pulses from RV at a cycle length 20 to 40 ms shorter than the tachycardia cycle length. A train of 15 pacing pulses was attempted if shorter pacing sequences were unsuccessful.…”

Section: Patient Characteristicsmentioning

confidence: 99%

A Simple Method to Differentiate Atrioventricular Node Reentrant Tachycardia from Orthodromic Reciprocating Tachycardia

Lei

Jia

et al. 2018

Int. Heart J.

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SummaryDiscrimination between atrioventricular node reentry tachycardia (AVNRT) and orthodromic reciprocating tachycardia (ORT) during an electrophysiological study is sometimes challenging. This study aimed to investigate if the difference in the local VA (ventricle-atrium) interval during ventricular entrainment pacing and during tachycardia (DVA, defined as the shortest local VA interval of coronary sinus [CS] during entrainment minus the shortest local VA interval of CS during tachycardia) was different in patients with AVNRT and patients with ORT.Diagnoses of AVNRT or ORT through a concealed accessory pathway (AP) were made according to conventional electrophysiological criteria and ablation results. Entrainment by right ventricular (RV) pacing was performed in each patient before ablation and patients with successful entrainment were included in the study. The DVA was compared between patients with AVNRT and patients with ORT. The DVA in patients with AVNRT was significantly longer than that in patients with ORT (120 ± 20 versus 5.7 ± 9; P < 0.001). In each patient with AVNRT of slow-fast type, fast-slow type, and slow-slow type, the DVA was more than 48 ms. In each patient with ORT using a left free wall accessory pathway (AP), right free wall AP, and septal AP, the DVA was less than 20 ms.DVA was found to be a rapid, useful test in distinguishing patients with AVNRT from those with ORT.(Int Heart J 2018; 59: 71-76) Key words: Mechanism, Electrophysiological examination, Ventricular entrainment pacing D iscrimination between atrioventricular node reentry (AVNRT) and orthodromic reciprocating tachycardia (ORT) during an electrophysiological study can be occasionally challenging. [1][2][3][4][5] Since the local ventricle and local atrium near the accessory pathway (AP) are components of ORT 6) and they are activated sequentially during entrainment and during tachycardia, the local ventricle-atrium (VA) interval near the AP during ventricular entrainment pacing of the tachycardia may be similar to the local VA interval near the AP during tachycardia. On the other hand, it has been established that the ventricle does not contain the component of the circuit of AVNRT,6) and therefore the local VA interval during entrainment may be different from that during tachycardia.Because almost all APs (except for the Mahaim bundle) were located in the mitral annulus or tricuspid annulus, we assumed the shortest local VA interval of the coronary sinus (CS) was the local VA interval when the AP was on the left side or in a septal location. For AVNRT, the local VA interval during entrainment of the tachycardia and that during the tachycardia should be different because the activation pattern during entrainment is different from that during tachycardia. When it comes to a right side AP, we aimed to investigate if there were properties of the local VA interval of the CS orifice using the right AP that could be used to differentiate ORT from AVNRT.In this study, we tested the value of a new parameter: the shortest VA interval...

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A technique for the rapid diagnosis of atrial tachycardia in the electrophysiology laboratory

Abstract: In conclusion, an A-A-V response upon cessation of ventricular pacing associated with 1:1 ventriculoatrial conduction is highly sensitive and specific for the identification of atrial tachycardia in the electrophysiology laboratory.

Cited by 256 publications

References 13 publications

Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Incorporating a “Superior” Slow Pathway

Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Incorporating a “Superior” Slow Pathway

Successful Ablation of Atypical Atrioventricular Nodal Reentrant Tachycardia From a Noncoronary Sinus of Valsalva

A Simple Method to Differentiate Atrioventricular Node Reentrant Tachycardia from Orthodromic Reciprocating Tachycardia

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