Anterograde His bundle activation during right ventricular overdrive pacing in supraventricular tachycardia.
Pacing Clin Electrophysiol
; 42(10): 1374-1382, 2019 10.
Article
en En
| MEDLINE
| ID: mdl-31407805
BACKGROUND: Differentiation between atrioventricular nodal re-entrant tachycardia (AVNRT), atrioventricular re-entrant tachycardia (AVRT), and atrial tachycardia (AT) is often challenging during electrophysiology studies. This study compared the sensitivity and specificity of identifying anterograde His bundle activation during entrainment with commonly used right ventricular (RV) pacing maneuvers to differentiate between these types of supraventricular tachycardia (SVT). METHODS: Out of 112 consecutive patients with SVT, 90 (36 males [40%], age 37 ± 16 years) were prospectively studied. After entrainment during RV pacing, atrial response upon cessation of pacing, anterograde His activation during entrainment, stimulus-atrial (SA), ventriculoatrial (VA) intervals, and post-pacing interval minus tachycardia cycle length (PPI-TCL) were determined. Ventricular extrastimulation during tachycardia and para-Hisian pacing were performed. RESULTS: The final diagnosis was AVNRT in 54, AVRT in 33, and AT in 3 patients. Entrainment was achieved in 87(96%) patients. Anterograde His bundle activation predicted AVRT (sensitivity: 62.5%, specificity: 100%). PPI-TCL ≥129 ms predicted AVNRT (sensitivity: 83%, specificity: 84%), as did SA-VA value ≥85 ms (sensitivity: 91%, specificity: 87%). Atria were advanced during transition zone in 57% of AVRTs. Atrial pre-excitation in response to progressively premature ventricular extrastimuli identified AVRT (sensitivity: 90%, specificity: 85%). Pre-excitation index ≥87 ms identified AVNRT (sensitivity: 80%, specificity: 100%). Para-Hisian pacing identified AVRT (sensitivity: 25%, specificity: 100%). CONCLUSION: RV pacing maneuvers, applied in isolation, can misclassify a significant proportion of SVTs. Identifying anterograde His bundle activation during entrainment can complement other discriminators in differential diagnosis of SVT, with greatest sensitivity in septal and right-sided accessory pathways.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Taquicardia Supraventricular
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Fascículo Atrioventricular
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Estimulación Cardíaca Artificial
Tipo de estudio:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Male
País/Región como asunto:
Africa
Idioma:
En
Revista:
Pacing Clin Electrophysiol
Año:
2019
Tipo del documento:
Article
País de afiliación:
Egipto
Pais de publicación:
Estados Unidos