Narrow QRS complex tachycardia with and without ventriculoatrial block: What is the mechanism?

Iwakawa, Hidehiro; Terata, Ken; Abe, Yoshihisa; Watanabe, Hiroyuki

doi:10.1016/j.hrthm.2022.07.023

Cited by 2 publications

(11 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Such observations supported the diagnosis of AVNRT; (1) absence of orthodromic His or septal ventricular capture and (2) a PPI − TCL of >125 ms or a corrected PPI − TCL of >110 ms after RVOP ( n = 9; Figure 2E). 2,4,5,7,9,12,13 Specifically, (3) the HA interval ≤ 70 ms ( n = 5; Figures 2F, 3C, 4A,B and 5A,B) supported the diagnosis of slow–fast AVNRT excluding the ORTs, as previously reported 2,4,8,14,15 . As shown in the Supplemental Figure S1, this NV‐ORT appeared to exhibit the HA interval of ≤70 ms.…”

Section: Resultssupporting

confidence: 79%

“…The first step was identification of the presence of a concealed atrioventricular AP or cNVP. The presence of either AP, except the NFP, was recognized on observation of tachycardia reset without any change in the atrial sequence and/or termination without atrial capture upon His‐refractory PVC that exhibited a fused QRS morphology 2,4–9 . In our study, presence of either AP was recognized in 14 of the 17 AVNRTs.…”

Section: Resultssupporting

confidence: 52%

“…However, the disappearance of the reset phenomenon upon delivery of an early PVC was also observed in the two patients with ORT via a cNVP (Supplemental fast AVNRT excluding the ORTs, as previously reported. 2,4,8,14,15 As shown in the Supplemental Figure S1, this NV-ORT appeared to exhibit the HA interval of ≤70 ms. However, this was attributed to an extremely long HA interval nearly equal to the TCL.…”

Section: Step 2 Exclusion Of Ort Via An Apmentioning

confidence: 71%

“…The most convincing explanation for the exceptional slow–fast AVNRT case, in which the atrial reset occurred before the His reset concurrent with a shift in atrial activation sequence, is that the PVC captured the atrium through the cNVP and the SP connected with the cNVP. This SP is distinct from the anterograde limb of the slow–fast AVNRT 8 . Therefore, the reset/termination sequence may be useful for verification of the AVN as the cNVP insertion site especially when the atrial activation sequence remains unchanged after the PVC.…”

Section: Discussionmentioning

confidence: 99%

“…Differentiation of orthodromic reciprocating tachycardia (ORT) incorporating a concealed nodoventricular pathway (cNVP) from atrioventricular nodal reentrant tachycardia (AVNRT) is particularly challenging and requires careful interpretation of the intracardiac electrograms 1–3 . Furthermore, differential diagnosis is not necessarily exclusive of ORT or AVNRT; there are several reports of AVNRT with a bystander cNVP 1–9 . However, criteria have not yet been developed for systematic diagnosis of AVNRT with a bystander cNVP because of the difficulty in differentiating this arrhythmia from NV‐ORT, and this lack leads to underdiagnosis.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Systematic observation‐based diagnosis of atrioventricular nodal reentrant tachycardia with a bystander concealed nodoventricular pathway

Nagashima,

Maruyama,

Kaneko

et al. 2023

Journal of Arrhythmia

Self Cite

View full text Add to dashboard Cite

BackgroundThis study aimed to establish a systematic method for diagnosing atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander concealed nodoventricular pathway (cNVP).MethodsWe analyzed 13 cases of AVNRT with a bystander cNVP, 11 connected to the slow pathway (cNVP‐SP) and two to the fast pathway (cNVP‐FP), along with two cases of cNVP‐related orthodromic reciprocating tachycardia (ORT).ResultsThe diagnostic process was summarized in three steps. Step 1 was identification of the presence of an accessory pathway by resetting the tachycardia with delay (n = 9) and termination without atrial capture (n = 4) immediately after delivery of a His‐refractory premature ventricular contraction (PVC). Step 2 was exclusion of ORT by atrio‐His block during the tachycardia (n = 4), disappearance of the reset phenomenon after the early PVC (n = 7), or dissociation of His from the tachycardia during ventricular overdrive pacing (n = 1). Moreover, tachycardia reset/termination without the atrial capture (n = 2/2) 1 cycle after the His‐refractory PVC was specifically diagnostic. Exceptionally, the disappearance of the reset phenomenon was also observed in the two cNVP‐ORTs. Step 3 was verification of the AVN as the cNVP insertion site, evidenced by an atrial reset/block preceding the His reset/block in fast–slow AVNRT with a cNVP‐SP and slow–fast AVNRT with a cNVP‐FP or His reset preceding the atrial reset in slow–fast AVNRT with a cNVP‐SP.ConclusionAVNRT with a bystander cNVP can be diagnosed in the three steps with few exceptions. Notably, tachycardia reset/termination without atrial capture one cycle after delivery of a His‐refractory PVC is specifically diagnostic.

show abstract

Section: Resultssupporting

confidence: 79%

Section: Resultssupporting

confidence: 52%

Section: Step 2 Exclusion Of Ort Via An Apmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Systematic observation‐based diagnosis of atrioventricular nodal reentrant tachycardia with a bystander concealed nodoventricular pathway

Nagashima,

Maruyama,

Kaneko

et al. 2023

Journal of Arrhythmia

Self Cite

View full text Add to dashboard Cite

show abstract

SVT quest: The adventure diagnosing narrow QRS tachycardia

Nagashima,

Michaud,

et al. 2024

Journal of Arrhythmia

View full text Add to dashboard Cite

In the field of cardiac electrophysiology, there is a universal desire: the discovery of a flawless diagnostic maneuver for supraventricular tachycardias (SVTs). This is not merely a wish but a shared odyssey. To improve diagnostic accuracy and achieve sufficient sensitivity and specificity, numerous diagnostic maneuvers have been proposed. However, each has its limitations and prompts a search for new diagnostic techniques. This continuous cycle of discovery and refinement, which we titled “SVT Quest” is reviewed in chronological sequence. This adventure in diagnosing narrow QRS tachycardia unfolds in 3 steps: Step 1 involves differentiating atrial tachycardia from other SVTs based on the observations such as V‐A‐V or V‐A‐A‐V response, ΔAA interval, VA linking, the last entrainment sequence, and response to the atrial extrastimulus. Step 2 focuses on differentiating orthodromic reciprocating tachycardia from atrioventricular nodal reentrant tachycardia based on the observations such as tachycardia reset upon the premature ventricular contraction during His refractoriness, uncorrected/corrected postpacing interval, differential ventricular entrainment, orthodromic His capture, transition zone analysis, and total pacing prematurity. Step 3 characterizes the concealed nodoventricular/nodofascicular pathway and His‐ventricular pathway‐related tachycardia based on observations such as V‐V‐A response, ΔatrioHis interval, and paradoxical reset phenomenon. There is no single diagnostic maneuver that fits all scenarios. Therefore, the ability to apply multiple maneuvers in a case allows the operator to accumulate evidence to make a likely diagnosis. Let's embark on this adventure!

show abstract

Narrow QRS complex tachycardia with and without ventriculoatrial block: What is the mechanism?

Cited by 2 publications

References 2 publications

Systematic observation‐based diagnosis of atrioventricular nodal reentrant tachycardia with a bystander concealed nodoventricular pathway

Systematic observation‐based diagnosis of atrioventricular nodal reentrant tachycardia with a bystander concealed nodoventricular pathway

SVT quest: The adventure diagnosing narrow QRS tachycardia

Contact Info

Product

Resources

About