Manuscript received 9 May 2007; Revised manuscript received 15 June 2007; Accepted for publication 20 June 2007.
The VA Relationship After Differential Atrial Overdrive Pacing: A Novel Tool for the Diagnosis of Atrial Tachycardia in the Electrophysiologic Laboratory
Article first published online: 16 AUG 2007
Journal of Cardiovascular Electrophysiology
Volume 18, Issue 11, pages 1127–1133, November 2007
How to Cite
MARUYAMA, M., KOBAYASHI, Y., MIYAUCHI, Y., INO, T., ATARASHI, H., KATOH, T. and MIZUNO, K. (2007), The VA Relationship After Differential Atrial Overdrive Pacing: A Novel Tool for the Diagnosis of Atrial Tachycardia in the Electrophysiologic Laboratory. Journal of Cardiovascular Electrophysiology, 18: 1127–1133. doi: 10.1111/j.1540-8167.2007.00928.x
- Issue published online: 18 OCT 2007
- Article first published online: 16 AUG 2007
- supraventricular tachycardia;
- atrial tachycardia;
- atrioventricular nodal reentry;
- differential diagnosis;
- ventriculoatrial conduction
Introduction: Despite recent advances in clinical electrophysiology, diagnosis of atrial tachycardia (AT) originating near Koch's triangle remains challenging. We sought a novel technique for rapid and accurate diagnosis of AT in the electrophysiologic laboratory.
Methods: Sixty-two supraventricular tachycardias including 18 ATs (10 ATs arising from near Koch's triangle), 32 atrioventricular nodal reentrant tachycardias (AVNRTs), and 12 orthodromic reciprocating tachycardias (ORTs) were studied. Overdrive pacing during the tachycardia from different atrial sites was performed, and the maximal difference in the postpacing VA intervals (last captured ventricular electrogram to the earliest atrial electrogram of the initial beat after pacing) among the different pacing sites was calculated (delta-VA interval).
Results: The delta-VA intervals were >14 ms in all AT patients and <14 ms in all AVNRT/ORT patients, and thus, the delta-VA interval was diagnostic for AT with the sensitivity, specificity, and positive and negative predictive values all being 100%. When the diagnostic value of the delta-VA interval and conventional maneuvers were compared for differentiating AT from atypical AVNRT, both a delta-VA interval >14 ms and “atrial-atrial-ventricular” response after overdrive ventricular pacing during the tachycardia were diagnostic. However, the “atrial-atrial-ventricular” response criterion was available in only 52% of the patients because of poor ventriculoatrial conduction.
Conclusions: The delta-VA interval was useful for diagnosing AT irrespective of patient conditions such as ventriculoatrial conduction.