Resetting criteria during ventricular overdrive pacing successfully differentiate orthodromic reentrant tachycardia from atrioventricular nodal reentrant tachycardia despite interobserver disagreement concerning QRS fusion

Rosman, Jonathan; John, Roy M.; Stevenson, William G.; Epstein, Laurence M.; Tedrow, Usha B.; Koplan, Bruce A.; Chen, Albert; Michaud, Gregory F.

doi:10.1016/j.hrthm.2010.09.089

Cited by 27 publications

(26 citation statements)

References 13 publications

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“…Our data are in accordance with AlMahameed et al, who have shown that AVNRT entrainment typically occurs after the TZ with no fusion in the surface ECG. 4,17 In our opinion, different mechanism may explain why the paced wave front reaches the parahisian ventricular myocardium before capturing the atrium through the conducting system. One involves the refractory His encountered by the late-coupled wave fronts at the beginning of the entrainment attempt.…”

Section: Rationale Of the Study And Mechanismmentioning

confidence: 92%

Differential Responses of the Septal Ventricle and the Atrial Signals During Ongoing Entrainment

Calvo

Ávila

García-Fernández

et al. 2015

Circ: Arrhythmia and Electrophysiology

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S eptal accessory pathways (APs) and atypical atrioventricular nodal reentry (AVNRT) commonly mediate supraventricular tachycardia with concentric atrial activation and long ventriculoatrial (VA) intervals. Several diagnostic maneuvers can aid differential diagnosis, including a return cycle after continuous entrainment from the right ventricular apex (RVA), 1,2 tachycardia resetting with electrocardiographic fusion, 3,4 and even responses to single ventricular extrastimulus.5 However, it has been reported that ≤15% to 20% of the tachycardia mechanism could be interrupted by the entrainment maneuvers. 5 In these instances, the utility of RVA pacing during tachycardia at the beginning of the entrainment attempt has received less attention as a diagnostic technique. Recently, AlMahameed et al elegantly © 2015 American Heart Association, Inc. ). SVE advancement preceding atrial reset was observed in 98% of atrioventricular nodal reentries during 4±1.1 cycles; this phenomena was observed in 6 (8%) of the atrioventricular reentrant tachycardia mediated by septal AP (P<0.001; sensitivity 98%; specificity 93%; positive predictive value 90%; negative predictive value 99%) and lasted 1 single cycle (P<0.001). Right posteroseptal AP tachycardias were distinctly characterized by atrial reset preceding SVE advancement (with ventricular fusion; specificity 100%; positive predictive value 100%). In 11 cases, it was impossible to achieve sustain entrainment. In all of them, the differential responses at the entrainment attempt allowed for appropriate diagnosis. Conclusions-The differential response of the SVE and the atrial electrogram at the initiation of continuous right ventricular apical pacing during tachycardia effectively distinguishes between atypical atrioventricular nodal reentry and atrioventricular reentrant tachycardia mediated by septal APs. (Circ Arrhythm Electrophysiol. Circ Arrhythm Electrophysiol

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Section: Rationale Of the Study And Mechanismmentioning

confidence: 92%

Differential Responses of the Septal Ventricle and the Atrial Signals During Ongoing Entrainment

Calvo

Ávila

García-Fernández

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…The TZ of RVOP was defined as the region that contained paced complexes with progressive QRS fusion and the first paced complex with a stable, fixed QRS morphology [17,18,19]. For the purpose of this analysis, the last QRS complex in the TZ is defined as ‘TZ'.…”

Section: Methodsmentioning

confidence: 99%

“…A fixed SA interval (SA fix) was defined as one varying by <10 ms. The first atrial capture beat complex that advanced to the PCL was identified by demonstrating a fixed AA interval with a <10-ms difference [17,18,19]. We numbered each QRS complex associated with each defined end point and included it in the analysis (fig.…”

Section: Methodsmentioning

confidence: 99%

“…Currently, the differential diagnosis of SVT can be established using various pacing techniques and maneuvers with a complex multi-electrode approach both in sinus rhythm such as para-Hisian pacing and analysis of the ventricular atrial conduction pattern and tachycardia. Diagnosis of the latter involves pre-excitation index, entrainment, atrioventricular (AV)/AAV phenomenon analysis after ventricular pacing, and the effects of premature atrial or ventricular beat, ventricular extrastimuli inducing tachycardia, fully right ventricular paced beats required to reset the tachycardia, and right ventricular overdrive pacing (RVOP) on atrial timing within the transition zone (TZ) during entrainment [8,9,10,11,12,13,14,15,16,17,18,19]. Moreover, entrainment of tachycardia with the assessment of the differences between tachycardia cycle length (TCL) and postpacing interval (PPI) as well as with the assessment of the stimulus to the last entrained atrial potential (SA) interval and the ventricle to atrium (VA) interval have been reported [20].…”

Section: Introductionmentioning

confidence: 99%

“…Analysis of RVOP may be a simple and effective technique to differentiate orthodromic AV reciprocating tachycardia (OAVRT) from typical and atypical AV nodal reentrant tachycardia (AVNRT) and atrial tachycardia (AT). Recently, retrospective studies using RVOP in complex multi-electrode approaches have shown that it has excellent diagnostic value [17,18,19]. However, these techniques use only 2 catheters and have not been prospectively validated.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Simplified Automated Right Ventricular Overdrive Pacing for Rapid Diagnosis of Supraventricular Tachycardia

Stec

Śledź²,

Mazij

et al. 2014

Cardiology

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Objectives: The purpose of this study was to prospectively evaluate the feasibility and diagnostic value of right ventricular overdrive pacing (RVOP) during supraventricular tachycardia (SVT) using a 2-catheter approach with automatic pacing from the right ventricular inflow (RVIT) and outflow tract (RVOT). Methods: One hundred and thirty-six consecutive patients (with 138 arrhythmias, mean age 36 ± 20 years, range 4-95) were enrolled in this study. Only coronary sinus and ablation catheters were used. RVOP was delivered from RVIT and then from RVOT. Each attempt consisted of 10 synchronized beats delivered at a cycle length of 10-40 ms longer than the tachycardia cycle length. Results: RVOP was sufficient to confirm the transition zone within the first 9 beats in the majority of SVTs. Atrial perturbation (acceleration, delayed) in the transition zone was detected in all patients with orthodromic atrioventricular (AV) reentry. Patients with typical AV nodal reentry, atypical AV nodal reentry and atrial tachycardia did not show atrial timing perturbation during fusion complexes of RVOP. Conclusions: Synchronized RVOP from RVIT or RVOT is an easy and accurate method for the quick and reliable differential diagnosis of SVT in various clinical settings, particularly when only a limited number of catheters are used.

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Mapping of Typical Preexcitation Syndromes

et al. 2012

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Resetting criteria during ventricular overdrive pacing successfully differentiate orthodromic reentrant tachycardia from atrioventricular nodal reentrant tachycardia despite interobserver disagreement concerning QRS fusion

Cited by 27 publications

References 13 publications

Differential Responses of the Septal Ventricle and the Atrial Signals During Ongoing Entrainment

Differential Responses of the Septal Ventricle and the Atrial Signals During Ongoing Entrainment

Simplified Automated Right Ventricular Overdrive Pacing for Rapid Diagnosis of Supraventricular Tachycardia

Mapping of Typical Preexcitation Syndromes

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