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Sukumaran SK, Bhargav A, Balaguru S, Selvaraj RJ. Conflicting responses with simultaneous atrioventricular pacing. What is the mechanism? Indian Pacing Electrophysiol J 2024:S0972-6292(24)00114-1. [PMID: 39178985 DOI: 10.1016/j.ipej.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/16/2024] [Accepted: 08/20/2024] [Indexed: 08/26/2024] Open
Abstract
A 60-year-old woman presented with recurrent episodes of palpitations, documented short RP, narrow QRS tachycardia and absence of preexcitation in the electrocardiogram during sinus rhythm. During an electrophysiology study, programmed stimulation induced a narrow QRS tachycardia with cycle length of 380 ms, VA interval of 164 ms and earliest atrial activation in the His region. Ventricular overdrive pacing failed to entrain the atrium even with isoprenaline infusion and atrial burst pacing repeatedly terminated the tachycardia. Difference in AH interval with pacing and SVT was 27 msec. Simultaneous atrial and ventricular pacing was done with atrial pacing from the high right atrium and showed a His signal as the first return electrogram suggestive of atrioventricular nodal reentrant tachycardia (AVNRT). The manoeuvre was repeated with atrial pacing from the proximal coronary sinus and showed an atrial signal as the first return electrogram suggestive of atrial tachycardia (AT). What is the explanation for the conflicting results of the two pacing maneuvers?
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Affiliation(s)
| | - Anish Bhargav
- Department of Cardiology, JIPMER, Pondicherry, India
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2
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Kaneko Y, Nakajima T, Tamura S, Nagashima K, Kobari T, Hasegawa H, Ishii H. Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V-A-A-V response. Pacing Clin Electrophysiol 2022; 45:839-852. [PMID: 35661184 DOI: 10.1111/pace.14540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The electrophysiological discrimination between fast-slow (F/S-) atrioventricular (AV) nodal reentrant tachycardia (NRT) and atrial tachycardia (AT) originating from the interatrial septum remains challenging. While a V-A-A-V response may occur immediately after ventricular induction or entrainment of either tachycardia, the electrophysiological dissimilarities in that response between the two tachycardias remain unclear. The purpose of this study was to identify a diagnostic indicator discriminating F/S-AVNRT from AT by examining the difference in the V-A-A-V response between the two tachycardias. METHODS This retrospective study included 17 patients with F/S-AVNRT [7 with common-form F/S-AVNRT using a typical slow pathway (SP) and 10 with superior type F/S-AVNRT using a superior SP] and 10 patients with reentrant AT. All 27 patients presented with long RP supraventricular tachycardia and an initial V-A-A-V response upon ventricular induction or entrainment. The V-A-A-V response in patients with F/S-AVNRT was due to dual atrial responses. We measured the interval between the first (A1) and second atrial electrogram (A2) of V-A-A-V and calculated ΔAA by subtracting A1-A2 from the tachycardia cycle length. RESULTS V-A-A-V responses were observed most often upon ventricular induction of F/S-AVNRT (6±5 times) as well as AT (6±6 times; P = 0.87). The V-A-A-V response upon ventricular entrainment was observed in a single patient with F/S-AVNRT versus 10 all patients with AT (P<0.001). ΔAA ranged between -80 and 228 ms in F/S-AVNRT and between -184 and 26 ms in AT. A ΔAA >26 ms predicted a diagnosis of F/S-AVNRT with a 76% sensitivity and 100% specificity, while a ΔAA ←80 ms predicted a diagnosis of AT with a 50% sensitivity and 100% specificity. CONCLUSIONS ΔAA is a useful, confirmatory, diagnostic indicator of F/S-AVNRT versus AT associated with the V-A-A-V response. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Koichi Nagashima
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Uetake S, Maruyama M, Miyauchi Y, Shimizu W. Distal type of nodo-ventricular pathway: Unique electrophysiological characteristics mimicking fasciculo-ventricular pathway. Pacing Clin Electrophysiol 2022; 45:900-903. [PMID: 35212400 DOI: 10.1111/pace.14468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/26/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
Fasciculo-ventricular and nodo-ventricular pathways (FVP and NVP) are rare preexcitation variants. Normally, NVP is electrophysiologically different from FVP. We describe a unique type of NVP emerging from the distal part of the slow pathway, designated as "distal type" NVP. The distal type NVP resembled FVP but was proven by unexpected elimination of the NVP during the slow pathway ablation. Also, NVP was distinguishable from FVP by a careful comparison of the HV intervals during conduction over the fast and slow pathways. Demonstration of this novel type NVP provides insights into how the insertion site of NVP affects its electrophysiologic behaviors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shunsuke Uetake
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Donnelly J, Gabriels J, Bhatia NK, Lloyd MS, El-Chami MF, Merchant FM. Diagnostic Pacing Maneuvers for Supraventricular Tachycardia Discrimination: a Taxonomic Approach. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00961-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Oesterle A, Lee AC, Voskoboinik A, Moss JD, Vedantham V, Walters TE, Lee BK, Tseng ZH, Gerstenfeld EP, Scheinman MM. Electrophysiologic approach to diagnosis and ablation of patients with permanent junctional reciprocating tachycardia associated with complex anatomy and/or physiology. J Cardiovasc Electrophysiol 2020; 31:3232-3242. [PMID: 33107135 DOI: 10.1111/jce.14788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/04/2020] [Accepted: 10/11/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Permanent junctional reciprocating tachycardia (PJRT) is a rare supraventricular tachycardia (SVT), typically involving a single decremental posteroseptal accessory pathway (AP). METHODS Four patients with long RP SVT underwent electrophysiology (EP) study and ablation. The cases were reviewed. RESULTS Case 1 recurred despite 3 prior ablations at the site of earliest retrograde atrial activation during orthodromic reciprocating tachycardia (ORT). Mapping during a repeat EP study demonstrated a prepotential in the coronary sinus (CS). Ablation over the earliest atrial activation in the CS resulted in dissociation of the potential from the atrium during sinus rhythm. The potential was traced back to the CS os and ablated. Case 2 underwent successful ablation at 6 o'clock on the mitral annulus (MA). ORT recurred and successful ablation was performed at 1 o'clock on the MA. Case 3 had tachycardia with variation in both V-A and A-H intervals which precluded the use of usual maneuvers so we used simultaneous atrial and ventricular pacing and introduced a premature atrial contraction with a closely coupled premature ventricular contraction. Case 4 had had two prior atrial fibrillation ablations with continued SVT over a decremental atrioventricular bypass tract that was successfully ablated at 5 o'clock on the tricuspid annulus. A second SVT consistent with a concealed nodoventricular pathway was successfully ablated at the right inferior extension of the AV nodal slow pathway. CONCLUSION We describe challenging cases of PJRT by virtue of complex anatomy, diagnostic features, and multiple arrhythmia mechanisms.
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Affiliation(s)
- Adam Oesterle
- Division of Cardiovascular Medicine, Department of Medicine, University of California Davis, Sacramento, California, USA
| | - Adam C Lee
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Aleksandr Voskoboinik
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Joshua D Moss
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Vasanth Vedantham
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Tomos E Walters
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Byron K Lee
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Zian H Tseng
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Edward P Gerstenfeld
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Melvin M Scheinman
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Kaneko Y, Nakajima T, Tamura S, Hasegawa H, Kobari T, Iizuka T, Kurabayashi M. Superior-Type Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Phenotype Mimicking the Slow-Fast Type. Circ Arrhythm Electrophysiol 2020; 13:e008732. [PMID: 33000970 DOI: 10.1161/circep.120.008732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Superior-type fast-slow (sup-F/S-) atrioventricular nodal reentrant tachycardia (AVNRT) is a rare AVNRT variant using a superior slow pathway (SP) as the retrograde limb. Its intracardiac appearance, characterized by a short atrio-His (AH) interval and the earliest site of atrial activation in the His-bundle, is an initial indicator for making a diagnosis. METHODS Among 22 consecutive patients with sup-F/S-AVNRT, 3 (age, 68-81 years) patients had an apparent slow-fast (S/F-) AVNRT characterized by a long AH interval and the earliest site of atrial activation in or superior to the His-bundle region (tachy-long-AH). RESULTS The diagnosis of sup-F/S-AVNRT was based on the standard criteria in 2 patients and on the occurrence of Wenckebach-type atrioventricular block during tachycardia, which was attributable to a block at the lower common pathway (LCP) below the circuit of the AVNRT, detected owing to the lower common pathway potentials, in one patient. As with the typical S/F-AVNRT, tachy-long-AH was induced after a jump in the AH interval. In contrast to typical S/F-AVNRT, fluctuation in the ventriculoatrial interval was observed during the tachy-long-AH. Ventricular overdrive pacing was unable to entrain or terminate the tachy-long-AH. Moreover, the tachy-long-AH reciprocally transited to/from sup-F/S-AVNRT spontaneously or was triggered by ventricular contractions while the atrial cycle length and earliest site of atrial activation remained unchanged. Both tachycardias were cured by ablation at a single site in the right-side para-Hisian region of 2 patients and the noncoronary aortic cusp of one patient. Collectively, the essential circuit of both tachycardias was identical, and the tachy-long-AH was diagnosed as another phenotype of sup-F/S-AVNRT accompanied by sustained antegrade conduction via another bystander slow pathway breaking through the His-bundle owing to the repetitive antegrade block at the lower common pathway, thus representing a long AH interval during the ongoing sup-F/S-AVNRT. CONCLUSIONS An unknown sup-F/S-AVNRT phenotype exists that apparently mimics the typical S/F-AVNRT and is also an unknown subtype of apparent S/F-AVNRT.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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Park JW, Ha YW, Kim SH, Oh YS. Diagnostic utility of atrial entrainment for differentiation of long RP tachycardia. Heart Rhythm 2020; 17:1629-1631. [PMID: 32868023 DOI: 10.1016/j.hrthm.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Jeong-Wook Park
- Cardiocerebrovascular Hospital, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Yeong-Woong Ha
- Cardiocerebrovascular Hospital, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Cardiocerebrovascular Hospital, Seoul St. Mary's Hospital, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Yong-Seog Oh
- Cardiocerebrovascular Hospital, Seoul St. Mary's Hospital, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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8
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The various manifestations of concealed nodofascicular/nodoventricular bypass tracts. Heart Rhythm 2020; 17:1280-1290. [DOI: 10.1016/j.hrthm.2020.03.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/29/2020] [Indexed: 12/24/2022]
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Weiss M, Ho RT. Pathophysiology, Diagnosis, and Ablation of Atrioventricular Node-dependent Long-R-P Tachycardias. J Innov Card Rhythm Manag 2020; 11:4046-4053. [PMID: 32368379 PMCID: PMC7192137 DOI: 10.19102/icrm.2020.110306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/17/2019] [Indexed: 11/15/2022] Open
Abstract
Atrioventricular (AV) node–dependent long-R–P tachycardias are a unique group of supraventricular tachycardias that include atypical AV nodal reentrant tachycardia (AVNRT), atypical AVNRT with a concealed bystander nodofascicular (NF)/nodoventricular (NV) accessory pathway inserting into the slow pathway of the AV node, the permanent form of junctional reciprocating tachycardia, and orthodromic NF/NV reciprocating tachycardia. Here, we discuss the complex pathophysiology, diagnosis, and ablation of these intriguing arrhythmias.
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Affiliation(s)
- Max Weiss
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Reginald T Ho
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
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Okabe T, Hummel JD, Kalbfleisch SJ. A long RP supraventricular tachycardia: What is the mechanism? Heart Rhythm 2017; 14:462-464. [DOI: 10.1016/j.hrthm.2016.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Indexed: 10/20/2022]
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12
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Katritsis DG, Josephson ME. Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia. Arrhythm Electrophysiol Rev 2016; 5:130-5. [PMID: 27617092 DOI: 10.15420/aer.2016.18.2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT) should be classified as typical or atypical. The term 'fast-slow AVNRT' is rather misleading. Retrograde atrial activation during tachycardia should not be relied upon as a diagnostic criterion. Both typical and atypical atrioventricular nodal reentrant tachycardia are compatible with varying retrograde atrial activation patterns. Attempts at establishing the presence of a 'lower common pathway' are probably of no practical significance. When the diagnosis of AVNRT is established, ablation should be only directed towards the anatomic position of the slow pathway. If right septal attempts are unsuccessful, the left septal side should be tried. Ablation targeting earliest atrial activation sites during typical atrioventricular nodal reentrant tachycardia or the fast pathway in general for any kind of typical or atypical atrioventricular nodal reentrant tachycardia, are not justified. In this review we discuss current concepts about the tachycardia circuit, electrophysiologic diagnosis, and ablation of this arrhythmia.
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Affiliation(s)
| | - Mark E Josephson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Katritsis DG, Josephson ME. Differential diagnosis of regular, narrow-QRS tachycardias. Heart Rhythm 2015; 12:1667-76. [DOI: 10.1016/j.hrthm.2015.03.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Indexed: 10/23/2022]
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Diagnosis and Ablation of Long RP Supraventricular Tachycardias. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:370. [DOI: 10.1007/s11936-015-0370-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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His overdrive pacing during supraventricular tachycardia: A novel maneuver for distinguishing atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia. Heart Rhythm 2014; 11:1327-35. [DOI: 10.1016/j.hrthm.2014.04.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Indexed: 11/18/2022]
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Spontaneous ECG observations during an incessant long RP tachycardia—What is the tachycardia mechanism? Heart Rhythm 2014; 11:325-7. [DOI: 10.1016/j.hrthm.2013.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Indexed: 11/21/2022]
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Ho RT, Frisch DR, Pavri BB, Levi SA, Greenspon AJ. Electrophysiological Features Differentiating the Atypical Atrioventricular Node–Dependent Long RP Supraventricular Tachycardias. Circ Arrhythm Electrophysiol 2013; 6:597-605. [DOI: 10.1161/circep.113.000187] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Reginald T. Ho
- From the Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA (R.T.H., D.R.F., B.B.P., A.J.G.); and Division of Cardiology, Our Lady of Lourdes Hospital, Camden, NJ (S.A.L.)
| | - Daniel R. Frisch
- From the Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA (R.T.H., D.R.F., B.B.P., A.J.G.); and Division of Cardiology, Our Lady of Lourdes Hospital, Camden, NJ (S.A.L.)
| | - Behzad B. Pavri
- From the Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA (R.T.H., D.R.F., B.B.P., A.J.G.); and Division of Cardiology, Our Lady of Lourdes Hospital, Camden, NJ (S.A.L.)
| | - Steven A. Levi
- From the Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA (R.T.H., D.R.F., B.B.P., A.J.G.); and Division of Cardiology, Our Lady of Lourdes Hospital, Camden, NJ (S.A.L.)
| | - Arnold J. Greenspon
- From the Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA (R.T.H., D.R.F., B.B.P., A.J.G.); and Division of Cardiology, Our Lady of Lourdes Hospital, Camden, NJ (S.A.L.)
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MILLER JOHNM, MASKOUN WADDAH. Back to Basics: The Value of Simple Diagnostic Maneuvers in Diagnosing Supraventricular Tachycardias. J Cardiovasc Electrophysiol 2013; 24:542-3. [DOI: 10.1111/jce.12110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- JOHN M. MILLER
- Krannert Institute of Cardiology, Department of Medicine; Indiana University School of Medicine; Indianapolis Indiana USA
| | - WADDAH MASKOUN
- Krannert Institute of Cardiology, Department of Medicine; Indiana University School of Medicine; Indianapolis Indiana USA
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Ho RT, Fischman DL. Entrainment versus resetting of a long RP tachycardia: What is the diagnosis? Heart Rhythm 2012; 9:312-4. [DOI: 10.1016/j.hrthm.2010.11.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Indexed: 10/18/2022]
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BHATTACHARYA SANJOY, SABA SAMIR. Pacing Maneuver in the Diagnosis of the Mechanism of Supraventricular Tachycardia. Pacing Clin Electrophysiol 2011; 34:e90-3. [DOI: 10.1111/j.1540-8159.2010.02812.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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23
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Nguyen DT, Scheinman M, Olgin J, Badhwar N. Wenckebach during supraventricular tachycardia. Circ Arrhythm Electrophysiol 2010; 3:671-3. [PMID: 21156779 DOI: 10.1161/circep.110.959361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Duy Thai Nguyen
- Cardiology Division, University of California, San Francisco, USA
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AlMahameed ST, Buxton AE, Michaud GF. New Criteria During Right Ventricular Pacing to Determine the Mechanism of Supraventricular Tachycardia. Circ Arrhythm Electrophysiol 2010; 3:578-84. [DOI: 10.1161/circep.109.931311] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Right ventricular pacing (RVP) during supraventricular tachycardia produces progressive QRS fusion before the QRS morphology becomes stable. This transition zone (TZ) may provide useful information for differentiating orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentrant tachycardia and atrial tachycardia independent of entrainment success.
Methods and Results—
We studied the effect of properly timed RVP on atrial timing during the TZ in 92 patients with supraventricular tachycardia who had RVP within 40 ms of the tachycardia cycle length. The TZ during RVP includes progressively fused QRS complexes and the first paced complex with a stable QRS morphology based on analysis of the 12-lead ECG. We also measured the stimulus-atrial interval from the end of the TZ and with each QRS complex thereafter until pacing was terminated or ventriculo-atrial block occurred. A fixed stimulus-atrial interval was defined as variation <10 ms during RVP. Atrial preexcitation, postexcitation, or supraventricular tachycardia termination with abrupt ventriculo-atrial block was observed within the TZ in 32 of 34 patients with ORT. A fixed stimulus-atrial interval was established within the TZ in 33 of 34 patients with ORT. At least 1 of these 2 responses was observed in all patients with ORT. None of the patients with atrioventricular nodal reentrant tachycardia or atrial tachycardia had atrial timing perturbed or a fixed stimulus-atrial interval established within the TZ.
Conclusions—
During RVP within 40 ms of the tachycardia cycle length, ORT is the likely mechanism when atrial timing is perturbed or a fixed stimulus-atrial interval is established within the TZ.
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Affiliation(s)
- Soufian T. AlMahameed
- From the Division of Cardiology (S.T.A., A.E.B.), Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI; and the Division of Cardiology (G.F.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Alfred E. Buxton
- From the Division of Cardiology (S.T.A., A.E.B.), Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI; and the Division of Cardiology (G.F.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Gregory F. Michaud
- From the Division of Cardiology (S.T.A., A.E.B.), Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI; and the Division of Cardiology (G.F.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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26
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Badhwar N. Introduction to Supraventricular Tachycardia. Card Electrophysiol Clin 2010; 2:179-181. [PMID: 28770746 DOI: 10.1016/j.ccep.2010.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Paroxysmal supraventricular tachycardia (PSVT) is a clinical syndrome characterized by a rapid tachycardia with an abrupt onset and termination cardiomyopathy. The three most common causes of PSVT are atrioventricular nodal reentrant tachycardia (50%-60%), atrioventricular reentrant tachycardia in patients with Wolff-Parkinson-White syndrome (25%-30%), and atrial tachycardia (10%). Rare causes of PSVT include focal junctional tachycardia, atriofascicular tachycardia, permanent reciprocating junctional tachycardia, and nodoventricular/nodofascicular tachycardia. This article, based on challenging PSVT cases, is a guide for clinicians dealing with diagnostic or therapeutic dilemmas in the electrophysiology laboratory.
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Affiliation(s)
- Nitish Badhwar
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California, San Francisco, 500 Parnassus Avenue, Box 1354, San Francisco, CA 94143-1354, USA
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EL-CHAMI MIKHAELF, BLATT JACOB, LLOYD MICHAELS. A Diagnostic Response of a Supraventricular Tachycardia to a Ventricular Premature Beat. Pacing Clin Electrophysiol 2009; 32:660-2. [DOI: 10.1111/j.1540-8159.2009.02341.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee KW, Badhwar N, Scheinman MM. Supraventricular Tachycardia—Part II: History, Presentation, Mechanism, and Treatment. Curr Probl Cardiol 2008; 33:557-622. [DOI: 10.1016/j.cpcardiol.2008.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Oh S, Choi EK, Chung JW, Choi YS. Atypical atrioventricular nodal reentrant tachycardia in a patient with fasciculoventricular pathway. Heart Rhythm 2006; 3:1085-7. [PMID: 16945807 DOI: 10.1016/j.hrthm.2006.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 05/07/2006] [Indexed: 11/22/2022]
Affiliation(s)
- Seil Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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30
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Katritsis DG, Camm AJ. Classification and differential diagnosis of atrioventricular nodal re-entrant tachycardia. ACTA ACUST UNITED AC 2006; 8:29-36. [PMID: 16627405 DOI: 10.1093/europace/euj010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Recent evidence on atrioventricular nodal re-entrant tachycardia has identified several types of this common arrhythmia, with potential therapeutic implications. This article reviews the relevant new information, discusses the differential diagnosis of atrioventricular nodal re-entrant tachycardia, and summarizes the electrophysiological criteria for classification of the various forms of the arrhythmia.
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31
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Affiliation(s)
- Eric Good
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, 48109, USA
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32
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Oh S, Choi YS, Sohn DW, Oh BH, Lee MM, Park YB. Differential Diagnosis of Slow/Slow Atrioventricular Nodal Reentrant Tachycardia from Atrioventricular Reentrant Tachycardia Using Concealed Posteroseptal Accessory Pathway by 12-Lead Electrocardiography. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2003; 26:2296-300. [PMID: 14675015 DOI: 10.1111/j.1540-8159.2003.00362.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Slow pathways are used as both antegrade and retrograde conduction pathway in slow/slow atrioventricular nodal reentrant tachycardia (SS-AVNRT), and patients with SS-AVNRT have tachycardia ECGs mimicking atrioventricular reentrant tachycardia using concealed posteroseptal accessory pathway (PS-AVRT). Therefore, SS-AVNRT can be misdiagnosed as PS-AVRT, and the differential diagnosis is clinically important. Standard 12-lead ECGs during tachycardia were analyzed in patients with SS-AVNRT (n = 10) and PS-AVRT (n = 10). All these patients were diagnosed by electrophysiological study and underwent successful catheter ablation. Differences of the RP' intervals (dRP') between V1 and the inferior leads were evaluated. SS-AVNRT had significantly longer RP' intervals measured in V1 (167 +/- 25.2 vs 137 +/- 26.8 ms, SS-AVNRT vs PS-AVRT, respectively, P = 0.02), longer dRP' between V1 and II (dRP'[V1-II], 37 +/- 14 vs 17 +/- 6.7 ms, P = 0.0007), longer dRP'[V1-III] (39 +/- 14 vs 17 +/- 9.9 ms, P = 0.0011), and longer dRP'[V1-aVF] (39 +/- 13 vs 20 +/- 9.5 ms, P = 0.0008). The following criteria were suggested for differential diagnosis of SS-AVNRT from PS-AVRT: dRP'[V1-II] >25 ms (sensitivity and specificity: 80% and 100%, respectively), dRP'[V1-III] >23 ms (90% and 90%), dRP'[V1-aVF] >30 ms (90% and 90%). Differences of the RP' intervals between V1 and the inferior leads in the tachycardia ECGs were useful for differential diagnosis of SS-AVNRT from PS-AVRT.
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Affiliation(s)
- Seil Oh
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Division of Cardiology, Cardiac Electrophysiology, McGuire VA Medical Center, Medical College of Virginia, Richmond, Virginia 23249, USA.
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Michaud GF, Tada H, Chough S, Baker R, Wasmer K, Sticherling C, Oral H, Pelosi F, Knight BP, Strickberger SA, Morady F. Differentiation of atypical atrioventricular node re-entrant tachycardia from orthodromic reciprocating tachycardia using a septal accessory pathway by the response to ventricular pacing. J Am Coll Cardiol 2001; 38:1163-7. [PMID: 11583898 DOI: 10.1016/s0735-1097(01)01480-2] [Citation(s) in RCA: 170] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether the response to ventricular pacing during tachycardia is useful for differentiating atypical atrioventricular node re-entrant tachycardia (AVNRT) from orthodromic reciprocating tachycardia (ORT) using a septal accessory pathway. BACKGROUND Although it is usually possible to differentiate atypical AVNRT from ORT using a septal accessory pathway, a definitive diagnosis is occasionally elusive. METHODS In 30 patients with atypical AVNRT and 44 patients with ORT using a septal accessory pathway, the right ventricle was paced at a cycle length 10 to 40 ms shorter than the tachycardia cycle length (TCL). The ventriculo-atrial (VA) interval and TCL were measured just before pacing. The interval between the last pacing stimulus and the last entrained atrial depolarization (stimulus-atrial [S-A] interval) and the post-pacing interval (PPI) at the right ventricular apex were measured on cessation of ventricular pacing. RESULTS All 30 patients with atypical AVNRT and none of the 44 patients with ORT using a septal accessory pathway had an S-A-VA interval >85 ms and PPI-TCL >115 ms. CONCLUSIONS The S-A-VA interval and PPI-TCL are useful in distinguishing atypical AVNRT from ORT using a septal accessory pathway.
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Affiliation(s)
- G F Michaud
- Division of Cardiology, Department of Internal Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island 02905, USA.
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Morady F. A regular, wide-QRS complex tachycardia: what is the tachycardia mechanism? J Cardiovasc Electrophysiol 1999; 10:623-4. [PMID: 10355706 DOI: 10.1111/j.1540-8167.1999.tb00721.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F Morady
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022, USA
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Nawata H, Yamamoto N, Hirao K, Miyasaka N, Kawara T, Hiejima K, Harada T, Suzuki F. Heterogeneity of anterograde fast-pathway and retrograde slow-pathway conduction patterns in patients with the fast-slow form of atrioventricular nodal reentrant tachycardia: electrophysiologic and electrocardiographic considerations. J Am Coll Cardiol 1998; 32:1731-40. [PMID: 9822103 DOI: 10.1016/s0735-1097(98)00433-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to define the electrophysiologic and electrocardiographic characteristics of fast-slow atrioventricular nodal reentrant tachycardia (AVNRT). BACKGROUND In fast-slow AVNRT the retrograde slow pathway (SP) is located in the posterior septum, whereas the anterograde fast pathway (FP) is located in the anterior septum; however, exceptions may occur. METHODS Twelve patients with fast-slow AVNRT were studied. To determine the location of the retrograde SP, atrial activation during AVNRT was examined while recording the electrograms from the low septal right atrium (LSRA) on the His bundle electrogram and the orifice of the coronary sinus (CS). Further, to investigate the location of the anterograde FP, single extrastimuli were delivered during AVNRT both from the high right atrium and the CS. RESULTS The CS activation during AVNRT preceded the LSRA in six patients (posterior type); LSRA activation preceded the CS in three patients (anterior type), and in the remaining three both sites were activated simultaneously (middle type). In the anterior type, CS stimulation preexcited the His and the ventricle without capturing the LSRA electrogram (atrial dissociation between the CS and the LSRA), suggesting that the anterograde FP was located posterior to the retrograde SP. In the posterior and middle types, high right atrial stimulation demonstrated atrial dissociation, suggesting that the anterograde FP was located anterior to the SP. In the posterior and middle types, retrograde P waves in the inferior leads were deeply negative, whereas they were shallow in the anterior type. CONCLUSIONS Fast-slow AVNRT was able to be categorized into posterior, middle and anterior types according to the site of the retrograde SP. The anterior type AVNRT, where an anteriorly located SP is used in the retrograde direction and a posteriorly located FP in the anterograde direction, appears to represent an anatomical reversal of the posterior type which uses a posterior SP for retrograde and an anterior FP for anterograde conduction. Anterior type AVNRT should be considered in the differential diagnosis of long RP (RP > PR intervals) tachycardias with shallow negative P waves in the inferior leads.
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Affiliation(s)
- H Nawata
- The First Department of Internal Medicine, Tokyo Medical and Dental University, Japan
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Swerdlow CD, Brewer JE, Kass RM, Kroll MW. Application of models of defibrillation to human defibrillation data: implications for optimizing implantable defibrillator capacitance. Circulation 1997; 96:2813-22. [PMID: 9386143 DOI: 10.1161/01.cir.96.9.2813] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Theoretical models predict that optimal capacitance for implantable cardioverter-defibrillators (ICDs) is proportional to the time-dependent parameter of the strength-duration relationship. The hyperbolic model gives this relationship for average current in terms of the chronaxie (t(c)). The exponential model gives the relationship for leading-edge current in terms of the membrane time constant (tau(m)). We hypothesized that these models predict results of clinical studies of ICD capacitance if human time constants are used. METHODS AND RESULTS We studied 12 patients with epicardial ICDs and 15 patients with transvenous ICDs. Defibrillation threshold (DFT) was determined for 120-microF monophasic capacitive-discharge pulses at pulse widths of 1.5, 3.0, 7.5, and 15 ms. To compare the predictions of the average-current versus leading-edge-current methods, we derived a new exponential average-current model. We then calculated individual patient time parameters for each model. Model predictions were validated by retrospective comparison with clinical crossover studies of small-capacitor and standard-capacitor waveforms. All three models provided a good fit to the data (r2=.88 to .97, P<.001). Time constants were lower for transvenous pathways (53+/-7 omega) than epicardial pathways (36+/-6 omega) (t(c), P<.001; average-current tau(m), P=.002; leading-edge-current tau(m), P<.06). For epicardial pathways, optimal capacitance was greater for either average-current model than for the leading-edge-current model (P<.001). For transvenous pathways, optimal capacitance differed for all three models (P<.001). All models provided a good correlation with the effect of capacitance on DFT in previous clinical studies: r2=.75 to .84, P<.003. For 90-microF, 120-microF, and 150-microF capacitors, predicted stored-energy DFTs were 3% to 8%, 8% to 16%, and 14% to 26% above that for the optimal capacitance. CONCLUSIONS Model predictions based on measured human cardiac-muscle time parameter have a good correlation with clinical studies of ICD capacitance. Most of the predicted reduction in DFT can be achieved with approximately 90-microF capacitors.
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Affiliation(s)
- C D Swerdlow
- Department of Medicine, Cedars-Sinai Medical Center, and University of California Los Angeles School of Medicine, 90048, USA.
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Swerdlow CD, Fan W, Brewer JE. Charge-burping theory correctly predicts optimal ratios of phase duration for biphasic defibrillation waveforms. Circulation 1996; 94:2278-84. [PMID: 8901683 DOI: 10.1161/01.cir.94.9.2278] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND For biphasic waveforms, it is accepted that the ratio of the duration of phase 2 to the duration of phase 1 (phase-duration ratio) should be < or = 1. The charge-burping theory postulates that the beneficial effects of phase 2 are maximal when it completely removes the charge delivered by phase 1. It predicts that the phase-duration ratio should be < 1 when the time constant of the defibrillation system (tau s) exceeds the time constant of the cell membrane (tau m) but > 1 when tau s < tau m. This study tested the hypothesis that the optimal phase-duration ratio depends on tau s (the product of the defibrillator capacitance and pathway resistance). METHODS AND RESULTS In a canine model of transvenous defibrillation (n = 8), we determined stored-energy defibrillation thresholds (DFTs) for biphasic waveforms from conventional capacitors (140 microF. tau s = 7.1 +/- 0.8 ms) and very small capacitors (40 microF. tau s = 2.0 +/- 0.2 ms). Each capacitance was tested with phase-duration ratios of 0.5, 1, 2, and 3. The duration of phase 1 approximated the optimal monophasic waveform, 6.3 +/- 0.7 ms for 140-microF waveforms and 2.8 +/- 0.2 ms for 40-microF waveforms. For 140-microF waveforms, the DFT was lower for phase-duration ratios < or = 1 than for phase-duration ratios > 1 (P = .0003). The reverse was true for 40-microF capacitors (P = .0008). There was a significant interaction between the effects of capacitance and phase-duration ratio on DFT (P = .0002). The lowest DFT for 40-microF waveforms was less than the lowest DFT for 140-microF waveforms (4.9 +/- 2.5 versus 6.4 +/- 2.4 J, P < .05). CONCLUSIONS The optimal phase-duration ratio is < or = 1 for conventional capacitors and > 1 for small capacitors. This supports the predictions of the charge-burping theory.
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Affiliation(s)
- C D Swerdlow
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, Calif, USA.
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