Use of Programmed Ventricular Extrastimulus During Supraventricular Tachycardia to Differentiate Atrioventricular Nodal Re-Entrant Tachycardia From Atrioventricular Re-Entrant Tachycardia

被引：3

作者：

Ito, Hiroyuki ^{[1
]}

Badhwar, Nitish ^{[2
]}

Patel, Akash R. ^{[3
]}

Hoffmayer, Kurt S. ^{[4
]}

Moss, Joshua D. ^{[2
]}

Pellegrini, Cara N. ^{[2
,5
]}

Vedantham, Vasanth ^{[2
]}

Tseng, Zian H. ^{[2
]}

Tanel, Ronn E. ^{[3
]}

Hsia, Henry H. ^{[2
,5
]}

Lee, Randall J. ^{[2
]}

Marcus, Gregory M. ^{[2
]}

Gerstenfeld, Edward P. ^{[2
]}

Scheinman, Melvin M. ^{[2
]}

机构：

[1] Showa Univ, Dept Med, Div Cardiol, Tokyo, Japan

[2] Univ Calif San Francisco, Div Cardiol, Sect Cardiac Electrophysiol, San Francisco, CA USA

[3] Univ Calif San Francisco, Dept Pediat, Div Pediat Cardiol, San Francisco, CA USA

[4] Univ Calif San Diego, Div Cardiol, Sect Electrophysiol, San Diego, CA 92103 USA

[5] San Francisco VA Med Ctr, San Francisco, CA USA

来源：

JACC-CLINICAL ELECTROPHYSIOLOGY | 2018年 / 4卷 / 07期

关键词：

coupling interval; premature ventricular extrastimulus; supraventricular tachycardia; ventricular entrainment; ventriculoatrial interval;

D O I：

10.1016/j.jacep.2018.01.020

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES This study hypothesized that early coupled ventricular extrastimuli (V-2) stimulation might yield a more robust differentiation between atrioventricular nodal re-entrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT). BACKGROUND Programmed V-2 during supraventricular tachycardia are useful to differentiate AVNRT from AVRT by subtracting the ventriculoatrial (VA) interval from the stimulus to atrial depolarization (stimulus atrial [SA]) interval, but all such maneuvers have limitations. METHODS Patients with either AVNRT or AVRT were investigated. The entire tachycardia cycle length (TCL) was scanned with V-2 delivered from the right ventricular apex. The SA-VA difference was calculated with V-2 clearly resetting the tachycardia. The prematurity of V-2 was calculated by dividing the coupling interval (CI) by the TCL. RESULTS A total of 210 patients (102 with AVNRT) were included. The SA-VA difference was >70 ms in all AVNRT patients and was <70 ms in all AVRT patients with right and septal accessory pathways (APs), except for those with decremental APs, in whom there was an overlap between AVNRT and AVRT with left APs. However, a SA-VA difference >110 ms with a CI/TCL of <65% distinguished AVNRT from AVRT using the left AP, with sensitivity and specificity of 87% and 100%, respectively. Ventricular overdrive pacing resulted in tachycardia termination or AV dissociation in 28% of patients compared with 15% of patients using the V-2 technique (p = 0.008). CONCLUSIONS A SA-VA of >70 ms using the V-2 technique differentiated AVNRT from AVRT using septal and right APs. Use of the V-2 technique with a short CI differentiated AVNRT from AVRT using left APs. The V-2 technique less frequently resulted in tachycardia termination compared with ventricular entrainment. (c) 2018 by the American College of Cardiology Foundation.

引用

页码：872 / 880

页数：9

共 15 条

[1] Performance of the SA-VA Difference to Differentiate Atrioventricular Nodal Reentrant Tachycardia from Orthodromic Reentrant Tachycardia in a Large Cohort of Consecutive Patients [J].