Differentiating Atrioventricular Nodal Reentrant Tachycardia from Junctional Tachycardia: Novel Application of the Delta H‐A Interval

Srivathsan, Komandoor; Gami, Apoor S.; Barrett, Renee; Monahan, Kristi; Packer, Douglas L.; Asirvatham, Samuel J.

doi:10.1111/j.1540-8167.2007.00961.x

Cited by 45 publications

(36 citation statements)

References 13 publications

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“…3 Once again, however, with fascicular arrhythmia, these maneuvers are not straightforward to perform because local capture typically involves the underlying fascicle, as well as the adjacent myocardium.…”

Section: Comparing Intervalsmentioning

confidence: 99%

“…Entrainment mapping is potentially useful for interrogating sites in complex circuits but requires the ability to capture the tissue generating the local signal that is being questioned as to whether it is in the circuit or not. 3 Because of the overlap between the fascicular tissue and the ventricular myocardium, capturing one without the other is difficult and not reproducibly done. Thus, one may capture the fascicle, the ventricular myocardium, or both, and this may vary from beat to beat.…”

Section: Entrainment Mappingmentioning

confidence: 99%

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Mapping and Ablation of Ventricular Tachycardia From the Left Upper Fascicle

Wang

Cingolani

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Section: Comparing Intervalsmentioning

confidence: 99%

Section: Entrainment Mappingmentioning

confidence: 99%

Mapping and Ablation of Ventricular Tachycardia From the Left Upper Fascicle

Wang

Cingolani

et al. 2013

Circ: Arrhythmia and Electrophysiology

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“…In a recent study, the average ⌬HA interval in AVNRT was Ϫ10 ms, although positive values were encountered. 48 Padanilam et al 49 described the use of premature atrial stimuli for differential diagnosis of slow-fast AVNRT and nonreentrant junctional tachycardia. An atrial premature complex that is timed to His refractoriness and advances the His electrogram of the subsequent cycle indicates that Figure 5.…”

Section: Avnrt Versus Nonreentrant Junctional Tachycardiasmentioning

confidence: 99%

Atrioventricular Nodal Reentrant Tachycardia

2010

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A trioventricular nodal reentrant tachycardia (AVNRT) represents the most common regular supraventricular arrhythmia in humans. 1 The precise anatomic site and nature of the pathways involved have not yet been established, and several attempts to provide a reasonable hypothesis based on anatomic or anisotropic models have been made. 2 There has been considerable evidence that the right and left inferior extensions of the human atrioventricular (AV) node and the atrionodal inputs they facilitate may provide the anatomic substrate of the slow pathway, and a comprehensive model of the tachycardia circuit for all forms of AVNRT based on the concept of atrionodal inputs has been proposed. 2 Still, however, the circuit of AVNRT remains elusive. Recently, time-honored conventional schemes for the diagnosis and classification of the various forms of the arrhythmia have been refuted in part by evolving evidence. Recognition of the various types of AVNRT is important, however, to expedite diagnosis and allow implementation of appropriate ablation therapy without complications. We present an update on AVNRT with a particular emphasis on electrophysiological criteria used for the differential diagnosis of regular, supraventricular tachycardias. ECG PresentationTypically, AVNRT is a narrow-complex tachycardia, ie, QRS duration Ͻ120 ms, unless aberrant conduction, which is usually of the right bundle-branch type, or a previous conduction defect exists. Tachycardia-related ST depression and RR-interval variation may be seen. RR alternans in AVNRT has been attributed to the proposed model of a figure of 8 reentry with continuous crossing over of antegrade activation through an inferior input to the contralateral superior input via the node. 2 In the typical form of AVNRT (slow-fast), abnormal (retrograde) PЈ waves are constantly related to the QRS and in the majority of cases are indiscernible or very close to the QRS complex (RPЈ/RR Ͻ0.5). Thus, PЈ waves are either masked by the QRS complex or seen as a small terminal PЈ wave that is not present during sinus rhythm (Figure 1). In the atypical form of AVNRT (fast-slow), PЈ waves are clearly visible before the QRS, ie, RPЈ/PЈR Ͼ0.75 (Figure 2), denoting a "long RP tachycardia," and are negative in leads II, III, aVF, and V 6 but positive in V 1 . PЈ waves are shallow in the inferior leads in the rare form of anterior fast-slow AVNRT. 3 Although AV dissociation is usually not seen, it can occur because neither the atria or the ventricles are necessary for the reentry circuit. If the tachycardia is initiated by atrial ectopic beats, the initial (ectopic) PЈ wave usually differs from the subsequent (retrograde) PЈ waves (Figure 1).

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“…On the contrary, the H-A interval may be shorter or longer during AVNRT when compared with ventricular pacing. 2,3 Because of the vagaries of conduction velocity and wavefront curvature around turnaround points, as well as autonomic tone, experimental evidence rather than deductive reasoning alone is needed to make arrhythmia differential diagnostic determinations. At present, such evidence for complex perinodal tachycardias is scarce.…”

Section: Comparatorsmentioning

confidence: 99%