Termination of a narrow complex tachycardia by a single extrastimulus: What is the mechanism?

Logue, Jonathan P.; Greenspon, Arnold J.; Ho, Reginald T.

doi:10.1016/j.hrthm.2018.06.029

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“…Most patients with AVNRT termination by a single VPB had a rather slow AVNRT rate. Other factors playing a role in the differences between AVNRT and AVRT in termination by a single VPB are the distance between the AVRT circuit and the AVNRT circuit from the RV apical stimulation site, and the difference in electrophysiologic properties of the tissue between VPB and the two tachycardia circuits (Kalbfleisch et al, ; Logue, Greenspon, & Ho, ). As shown in Figure , in AVRT, a VPB can more easily invade and collide with the circulating impulse because of the large tachycardia circuit.…”

Section: Discussionmentioning

confidence: 99%

When and how does a single ventricular premature beat initiate and terminate supraventricular tachycardia?

Guerra

Lokhandwala²,

Oyarzun

et al. 2019

Noninvasive Electrocardiol

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Background:The differential diagnosis of a supraventricular tachycardia (SVT) is accomplished using a number of pacing maneuvers. The incidence and mechanism of a single ventricular premature beat (VPB) on initiation and termination of tachycardia were evaluated during programmed electrical stimulation (PES) of the heart in patients with the two most common regular SVTs: atrioventricular re-entrant tachycardia (AVNRT) and orthodromic atrioventricular tachycardia (AVRT). Methods:Three hundred and thirty-seven consecutive patients aged above 18 years with an inducible sustained AVNRT or AVRT were prospectively enrolled. Patients with more than one tachyarrhythmia mechanism were excluded. Two hundred and seventeen patients (64.4%) had typical slow/fast AVNRT and 120 (35.6%) had an orthodromic AVRT using a rapidly conducting accessory pathway for V-A conduction.In this cross-sectional study, we specifically report the analysis of tachycardia induction and termination by a single VPB.Results: Tachycardia induction with a single VPB during sinus rhythm was seen in 7 of 120 AVRT and in only one of the 217 patients with AVNRT, (5.8% vs. 0.3%, p < 0.05). When a single VPB was delivered during basic ventricular pacing these values were 28% versus 4%, respectively, (p < 0.001). Termination of tachycardia by a single VPB was observed in nine (4.1%) patients with AVNRT and in 57 (47.5%) with AVRT (p < 0.001).Conclusion: Initiation of SVT by a single VPB during sinus rhythm was uncommon and favored AVRT. Termination of SVT by a single VPB was commonly seen in AVRT but rarely in AVNRT. These findings can be of help when interpreting a noninvasive arrhythmia event recording. K E Y W O R D Scardiac rhythm event recorders, electrophysiologic study, supraventricular tachycardia, tachycardia mechanisms

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Section: Discussionmentioning

confidence: 99%