Differentiation of Atrioventricular Nodal Reentrant Tachycardia from Orthodromic Reciprocating Tachycardia by the Resetting Response to Ventricular Extrastimuli: Comparison to Response to Continuous Ventricular Pacing
Article first published online: 1 FEB 2013
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 5, pages 534–541, May 2013
How to Cite
JAVIER GARCÍA-FERNÁNDEZ, F., ALMENDRAL, J., MARTA PACHÓN, GONZÁLEZ-TORRECILLA, E., MARTÍN, J. and GALLARDO, R. (2013), Differentiation of Atrioventricular Nodal Reentrant Tachycardia from Orthodromic Reciprocating Tachycardia by the Resetting Response to Ventricular Extrastimuli: Comparison to Response to Continuous Ventricular Pacing. Journal of Cardiovascular Electrophysiology, 24: 534–541. doi: 10.1111/jce.12079
- Issue published online: 26 APR 2013
- Article first published online: 1 FEB 2013
- Accepted manuscript online: 28 DEC 2012 02:01AM EST
- Manuscript Accepted: 17 DEC 2012
- Manuscript Revised: 28 NOV 2012
- Manuscript Received: 11 SEP 2012
- atrioventricular nodal reentrant tachycardia;
- catheter ablation;
- orthodromic reentrant tachycardia;
- supraventricular tachycardia
Resetting Response to Differentiate SVT
The usefulness of ventricular entrainment to differentiate AV nodal reentrant tachycardia (AVNRT) from orthodromic reciprocating tachycardia (ORT) by substracting the corrected postpacing interval (cPPI) from the tachycardia cycle length (TCL) or the ventriculoatrial interval during stimulation (SA) from that during tachycardia (VA) have been widely validated. However, some tachycardias are interrupted by pacing trains but may not be so by ventricular extrastimuli resulting in resetting.
To validate prospectively the diagnostic yield of cPPI-TCL and SA-VA measurements after resetting and to determine the proportion of AVNRT and ORT that can be entrained and/or reset from the right ventricular apex (RVA).
223 consecutive patients with inducible AVNRT or ORT underwent pacing trains and single extrastimulus (also double extrastimuli if singles did not reset tachycardia) at the RVA. We calculated cPPI-TCL and SA-VA during entrainment and resetting.
Entrainment could not be achieved in 15.2% of tachycardias because of consistent tachycardia interruption by pacing; resetting was observed in 99.5%. Values of cPPI-TCL and SA-VA > 110 milliseconds after resetting identified AVNRT as accurately as after entrainment. Values for cPPI-TCL/ SA-VA were: sensitivity: 98/100%; specificity: 96/98%; positive predictive value: 98/99%; negative predictive value: 98/100%.
Determinations of cPPI-TCL and SA-VA after resetting with single or double RVA extrastimuli are useful maneuvers to differentiate AVNRT from ORT and can be used for nearly every inducible AVNRT or ORT, even if they are interrupted by ventricular trains.