Magno Cunha Guerra1, Yash Lokhandwala2, Rodulfo Oyarzun3, Aniruddha Vyas4, Frederico Soares Correa5, Fernando Eugenio Cruz Filho6, Hein J Wellens7, Eduardo Back Sternick1,5. 1. Faculdade Ciências Médicas, Ciências Médicas-MG, Belo Horizonte, Brazil. 2. Arrhythmia Associates, Mumbai, India. 3. Instituto Nacional del Torax, Santiago, Chile. 4. Medanta Hospital, Indore, India. 5. Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil. 6. Instituto de Cardiologia, Ministério da Saúde, Rio de Janeiro, Brazil. 7. Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Abstract
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.
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.
Authors: Matthew T Bennett; Peter Leong-Sit; Lorne J Gula; Allan C Skanes; Raymond Yee; Andrew D Krahn; Ellaina C Hogg; Elaina C Hogg; George J Klein Journal: Circ Arrhythm Electrophysiol Date: 2011-06-02
Authors: K Hirao; K Otomo; X Wang; K J Beckman; J H McClelland; L Widman; M D Gonzalez; M Arruda; H Nakagawa; R Lazzara; W M Jackman Journal: Circulation Date: 1996-09-01 Impact factor: 29.690
Authors: B P Knight; A Zivin; J Souza; M Flemming; F Pelosi; R Goyal; C Man; S A Strickberger; F Morady Journal: J Am Coll Cardiol Date: 1999-03 Impact factor: 24.094
Authors: Esteban González-Torrecilla; Jesús Almendral; Francisco J García-Fernández; Miguel A Arias; Angel Arenal; Felipe Atienza; Tomás Datino; Leonardo F Atea; David Calvo; Marta Pachón; Francisco Fernández-Avilés Journal: J Cardiovasc Electrophysiol Date: 2011-03-08
Authors: J M Ormaetxe; J Almendral; A Arenal; J D Martínez-Alday; A Pastor; J P Villacastín; J L Delcán Journal: Circulation Date: 1993-12 Impact factor: 29.690