Diagnostic value of tachycardia features and pacing maneuvers during paroxysmal supraventricular tachycardia

Knight, Bradley P.; Ebinger, Matthew; Oral, Hakan; Kim, Michael; Sticherling, Christian; Pelosi, Frank; Michaud, Gregory F.; Strickberger, S. Adam; Morady, Fred

doi:10.1016/s0735-1097(00)00770-1

Cited by 328 publications

(268 citation statements)

References 15 publications

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“…A diagnosis of AT was confirmed by the response of tachycardia to standard pacing maneuvers, including an A-A-V response following ventricular pacing with 1:1 atrial capture. 8 Three-dimensional electroanatomical mapping was performed during AT to localize the site of origin for focal AT and to delineate the tachycardia circuit for macroreentrant AT. Electroanatomic mapping was performed using either the CARTO (Biosense Webster, Diamond Bar, CA) or Ensite NavX (St Jude Medical, St. Paul, MN) mapping system.…”

Section: Baseline Electrophysiology Studymentioning

confidence: 99%

Unifying Algorithm for Mechanistic Diagnosis of Atrial Tachycardia

Liu

Cheung

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-No existing criteria unequivocally differentiate focal atrial tachycardia (AT) caused by microreentry, triggered activity, or enhanced automaticity. Although macroreentrant AT is readily diagnosed based on entrainment criteria, the smaller circuit dimension associated with microreentrant AT makes it challenging to validate the presence of reset with fusion. An algorithm was, therefore, developed that is independent of entrainment but which reliably identifies specific mechanisms of focal AT. Methods and Results-Fifty-nine patients with AT underwent adenosine testing after mapping of tacycardia. Ten ATs had nonfocal activation, with ≥90% of tachycardia cycle length identified with electroanatomical mapping, findings consistent with macroreenty. All ATs were insensitive to adenosine. Forty-nine patients had focal AT with centrifugal activation. In 32/49 (67%) ATs, electrograms were nonfractionated, and <50% of tachycardia cycle length could be mapped. Based on programmed stimulation, 26/32 (81%) of these ATs were classified as due to triggered activity and 6/32 (19%) as due to enhanced automaticity. Adenosine terminated 100% of triggered ATs and transiently slowed or suppressed 100% of automatic ATs. The remaining 17 focal ATs had localized fractionated electrograms (≥35% of tachycardia cycle length) at the site of successful ablation and were classified as microreentrant. Adenosine had no effect in these ATs. The response to adenosine accurately differentiated all subtypes of focal AT, P<0.05. Conclusions-Adenosine-sensitivity (termination or transient slowing/suppression) in response to adenosine was 100% sensitive and specific for identifying focal AT mechanisms due to triggered activity or automaticity, respectively. Absence of adenosine effect on focal AT identifies tachycardia due to microreentry. Methods Study PopulationWe studied 59 consecutive patients who presented for invasive electrophysiological evaluation and catheter ablation of AT and received adenosine during tachycardia. The presence of structural heart disease was based on a diagnosis of cardiomyopathy, valvular disease, coronary artery disease (> 60% stenosis), or prior myocardial infarction. All procedures were performed after informed consent was obtained for a study approved by the Institutional Review Board of Weill Cornell Medical College. Baseline Electrophysiology StudyAll patients underwent electrophysiology study in a postabsorptive state. Antiarrhythmic drugs were held for 5 half-lives before the study. Quadripolar catheters were positioned at the His bundle position and right ventricular apex. Right atrial electrogram recordings were obtained with either a quadripolar catheter positioned in the high right atrium or a 7-Fr duodecapolar catheter positioned along the tricuspid annulus. A 6-Fr decapolar catheter was positioned in the coronary sinus to record left atrial and left ventricular activity. In selected patients, a 5-spline mapping catheter configured as radial spokes was deployed (PentaRay Nav; Biosense-Webster, Dia...

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Section: Baseline Electrophysiology Studymentioning

confidence: 99%

Unifying Algorithm for Mechanistic Diagnosis of Atrial Tachycardia

Liu

Cheung

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…In clinical practice, pacing or other maneuvers cannot be applied in all cases, and multiple criteria must be used for the differential diagnosis of narrow-complex tachycardias with atypical characteristics. 42 …”

Section: Tachycardia Entrainmentmentioning

confidence: 99%

Atrioventricular Nodal Reentrant Tachycardia

2010

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A trioventricular nodal reentrant tachycardia (AVNRT) represents the most common regular supraventricular arrhythmia in humans. 1 The precise anatomic site and nature of the pathways involved have not yet been established, and several attempts to provide a reasonable hypothesis based on anatomic or anisotropic models have been made. 2 There has been considerable evidence that the right and left inferior extensions of the human atrioventricular (AV) node and the atrionodal inputs they facilitate may provide the anatomic substrate of the slow pathway, and a comprehensive model of the tachycardia circuit for all forms of AVNRT based on the concept of atrionodal inputs has been proposed. 2 Still, however, the circuit of AVNRT remains elusive. Recently, time-honored conventional schemes for the diagnosis and classification of the various forms of the arrhythmia have been refuted in part by evolving evidence. Recognition of the various types of AVNRT is important, however, to expedite diagnosis and allow implementation of appropriate ablation therapy without complications. We present an update on AVNRT with a particular emphasis on electrophysiological criteria used for the differential diagnosis of regular, supraventricular tachycardias. ECG PresentationTypically, AVNRT is a narrow-complex tachycardia, ie, QRS duration Ͻ120 ms, unless aberrant conduction, which is usually of the right bundle-branch type, or a previous conduction defect exists. Tachycardia-related ST depression and RR-interval variation may be seen. RR alternans in AVNRT has been attributed to the proposed model of a figure of 8 reentry with continuous crossing over of antegrade activation through an inferior input to the contralateral superior input via the node. 2 In the typical form of AVNRT (slow-fast), abnormal (retrograde) PЈ waves are constantly related to the QRS and in the majority of cases are indiscernible or very close to the QRS complex (RPЈ/RR Ͻ0.5). Thus, PЈ waves are either masked by the QRS complex or seen as a small terminal PЈ wave that is not present during sinus rhythm (Figure 1). In the atypical form of AVNRT (fast-slow), PЈ waves are clearly visible before the QRS, ie, RPЈ/PЈR Ͼ0.75 (Figure 2), denoting a "long RP tachycardia," and are negative in leads II, III, aVF, and V 6 but positive in V 1 . PЈ waves are shallow in the inferior leads in the rare form of anterior fast-slow AVNRT. 3 Although AV dissociation is usually not seen, it can occur because neither the atria or the ventricles are necessary for the reentry circuit. If the tachycardia is initiated by atrial ectopic beats, the initial (ectopic) PЈ wave usually differs from the subsequent (retrograde) PЈ waves (Figure 1).

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“…Septal ventriculo-atrial (VA) interval −13 ms excludes orthodromic reentry tachycardia. 2 Atrial tachycardia usually has shorter AH interval but is possible with slow pathway atrionodal conduction resulting in long AH (≈268 ms) with each A generating a QRS timing with subsequent A activation (green arrows). Junctional tachycardia is epidemiologically unlikely in this clinical situation but is a possibility.…”

Section: Explanationmentioning

confidence: 99%

February 5th Question

Noheria¹

2018

Circ: Arrhythmia and Electrophysiology

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A 64-year-old man with frequent symptomatic premature ventricular complexes is brought to the electrophysiology laboratory for premature ventricular complex ablation. Earliest site of activation during premature ventricular complex is noted at location of ablation catheter (ABL; Figure), a consistent far-field signal 48 ms ahead of onset of QRS. Irrigated radiofrequency ablation (40 watts; 30 mL/min) is performed at this site. What structure could sustain collateral injury during ablation? Answer OptionsA. Left anterior descending coronary artery B. Left circumflex coronary artery C. Right coronary artery D. Atrioventricular node E. Right bundle branch February 5th Question

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Diagnostic value of tachycardia features and pacing maneuvers during paroxysmal supraventricular tachycardia

Cited by 328 publications

References 15 publications

Unifying Algorithm for Mechanistic Diagnosis of Atrial Tachycardia

Unifying Algorithm for Mechanistic Diagnosis of Atrial Tachycardia

Atrioventricular Nodal Reentrant Tachycardia

February 5th Question

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