Differential Responses of the Septal Ventricle and the Atrial Signals During Ongoing Entrainment: A Method to Differentiate Orthodromic Reciprocating Tachycardia Using Septal Accessory Pathways From Atypical Atrioventricular Nodal Reentry

Circulation. Arrhythmia and Electrophysiology
David CalvoJesús Almendral

Abstract

Differential diagnosis between tachycardia mediated by septal accessory pathways (AP) and atypical atrioventricular nodal reentry can be challenging. We hypothesized that an immediate versus delayed pace-related advancement of the atrial electrogram, once the local septal parahisian ventricular electrogram (SVE) has been advanced, may help in this diagnosis. We focused on differential timing between SVE and atrial signals at the initiation of continuous right ventricular apical pacing during tachycardia. SVE advancement preceding atrial reset was defined as SVE advanced by the paced wave fronts while atrial signal continued at the tachycardia cycle. We analyzed 51 atypical atrioventricular nodal reentry (45% posterior type) and 80 AP tachycardias (anteroseptal [10], parahisian [18], midseptal [12], and posteroseptal [40]). SVE advancement preceding atrial reset was observed in 98% of atrioventricular nodal reentries during 4±1.1 cycles; this phenomena was observed in 6 (8%) of the atrioventricular reentrant tachycardia mediated by septal AP (P<0.001; sensitivity 98%; specificity 93%; positive predictive value 90%; negative predictive value 99%) and lasted 1 single cycle (P<0.001). Right posteroseptal AP tachycardias were distin...Continue Reading

References

Aug 10, 2000·Journal of the American College of Cardiology·B P KnightF Morady
Jul 20, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Gopi DandamudiJohn M Miller
Oct 26, 2010·Circulation. Arrhythmia and Electrophysiology·Soufian T AlMahameedGregory F Michaud

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Citations

Jan 5, 2018·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·David CalvoCésar Morís
Apr 20, 2021·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Péter KupóRóbert Pap

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