Long RP interval tachycardia. What is the mechanism?

Jiménez‐Díaz, Javier; González-Marín, María-Arantzazu; González-Ferrer, Juan José; Higuera‐Sobrino, Felipe

doi:10.1016/j.joa.2016.06.004

Cited by 5 publications

(6 citation statements)

References 4 publications

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“…8 In our case, because of the incessant tachycardia, we could not pace the atrium in sinus rhythm. However, the AH intervals during SVT and atrial pacing were similar to that during sinus rhythm.…”

Section: Hr Poghosyan Ab Danoyan Tb Hovakimyan Et Almentioning

confidence: 80%

See 1 more Smart Citation

An Uncommon Case of Incessant Tachycardiainduced Cardiomyopathy in a Child

Poghosyan

Danoyan

Hovakimyan

et al. 2017

J Innov Cardiac Rhythm Manage

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An AXIOM Sensis XP system (Siemens AG, Munich, Germany) was also used during the procedure.Narrow complex tachycardia with a cycle length (CL) of 360 ms was ongoing. The earliest atrial activations were recorded in the left posterolateral wall (ie, at 4 o'clock according to the clinical standard nomenclature by Cosio) with the shortest ventriculoatrial (VA) interval equal to 104 ms. Few sinus complexes were recorded with concentric ventricular activation (Figure 2A). The atrium to His (AH) and His to ventricle intervals were 94 ms and 50 ms, respectively ( Figure 2B). The post-pacing interval was 492 ms with a ventricle-atrium-ventricle (VAV) response during overdrive pacing and entrainment of tachycardia from the right ventricle ( Figure 2C). Ventricular pacing within 40 ms of the His potential advanced the atrium and the atrial activation sequence to the same as that seen during tachycardia ( Figure 2D). The ventricular pacing given earlier terminated the tachycardia without advancing to the atrium ( Figure 2E). The VA interval was not decremental, although the tachycardia CL fluctuated from 310 ms to 360 ms. Because of the incessant tachycardia, we could not pace the atrium in sinus rhythm; however, the short attempts showed that the AH intervals during the sinus complexes and the atrial pacing in tachycardia CL were similar. Orthodromic atrioventricular reentrant tachycardia (AVRT) with concealed slow conductive accessory pathway (AP) was diagnosed. Case presentationA nine-year-old girl was admitted to our clinic having presented with palpitation, dyspnea, and heart failure (New York Heart Association functional classification class II). A 12-lead resting electrocardiogram (ECG) revealed regular narrow complex tachycardia (Figure 1). Echocardiography revealed reduced left ventricular systolic function (ejection fraction was 35%) and normal biatrial diameter. Tachycardia was incessant, lasting more than 50% of monitoring time prior to drug administration. Intravenous adenosine and b-blocker medication were ineffective. The patient was referred for electrophysiology (EP) study and catheter ablation. The procedure was performed with the patient under sedation with intubation. A steerable decapolar catheter (Abbott Laboratories, Chicago, IL, USA) was inserted into the coronary sinus via the subclavian vein, a quadripolar catheter (Abbott Laboratories, Chicago, IL, USA) was positioned in the right ventricle, and an ablation catheter (Marinr ® MC; Medtronic, Minneapolis, MN, USA) was placed in the His position via the right femoral vein during the EP study.ABSTRACT. The case of a pediatric patient with a history of incessant narrow complex tachycardia is presented. The patient underwent successful catheter ablation for an uncommon concealed slow accessory pathway. The mechanism and ablation location are discussed.

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Section: Hr Poghosyan Ab Danoyan Tb Hovakimyan Et Almentioning

confidence: 80%

“…During PJRT, this interval is a true interval, similar to the AH interval, when pacing at the tachycardia CL (difference of < 20 ms). 8 …”

Section: Incessant Tachycardia-induced Cardiomyopathy In a Childmentioning

confidence: 99%

An Uncommon Case of Incessant Tachycardiainduced Cardiomyopathy in a Child

Poghosyan

Danoyan

Hovakimyan

et al. 2017

J Innov Cardiac Rhythm Manage

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“…In AT, the RP/PR ratio is higher, the inverted P wave in inferior leads is uncommon, the P wave duration is longer and there is persistence of the tachycardia with P waves marching through during AV block. 17,18 Definitive diagnosis of the arrhythmia substrate requires intracardiac electrophysiologic (EP) study.…”

Section: Diagnosismentioning

confidence: 99%

“…In SVT with long RP interval, the possible diagnoses include atypical AVNRT, PJRT, atrial tachycardia, sinus tachycardia, sinus node reentry tachycardia and atrial flutter with 1:1 conduction. In AT, the RP/PR ratio is higher, the inverted P wave in inferior leads is uncommon, the P wave duration is longer and there is persistence of the tachycardia with P waves marching through during AV block . Definitive diagnosis of the arrhythmia substrate requires intracardiac electrophysiologic (EP) study.…”

Section: Introductionmentioning

confidence: 99%

“…The EP criteria for diagnosis include transient interruption of the PJRT by programmed stimulation with prompt resumption after few sinus beats, delay in atrial electrogram with an identical atrial activation sequence during PJRT via ventricular extrastimulus when the His bundle is refractory; atrial activation sequence during ventricular pacing that is identical to the pattern during tachycardia; and no anterograde conduction through the accessory pathway, but slow and decremental retrograde conduction through the accessory pathway . The post pacing interval (PPI) to tachycardia cycle length (TCL) difference of <110 ms and the stimulus to atrial (SA) to venticuloatrial (VA) difference of <85 ms excludes an AVNRT and suggests a septal accessory pathway.…”

Section: Introductionmentioning

confidence: 99%

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Permanent junctional reciprocating tachycardia in infants and Children

Kylat

Samson

2019

Journal of Arrhythmia

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Permanent junctional reciprocating tachycardia ( PJRT ) is a rare form of supraventricular tachycardia ( SVT ). It generally presents in infants but can be difficult to diagnose. The characteristic EKG findings, response to Adenosine and persistence or frequent recurrences are helpful in making the diagnosis. It is usually difficult to manage with the initial and single medications used in SVT . Many patients are misdiagnosed and not treated effectively and end up having end stage cardiomyopathy and are diagnosed in patients referred for transplant. Hence all patients referred for a cardiac transplant with dilated cardiomyopathy need to be evaluated for this arrhythmia. If appropriate treatment is started early in the course, the failure can be ameliorated, and the cardiomyopathy can be resolved.

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Taking Time With the RP Interval in Narrow Complex Tachycardia

Cunningham

Borne

2021

JAMA Intern Med

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Long RP interval tachycardia. What is the mechanism?

Cited by 5 publications

References 4 publications

An Uncommon Case of Incessant Tachycardiainduced Cardiomyopathy in a Child

An Uncommon Case of Incessant Tachycardiainduced Cardiomyopathy in a Child

Permanent junctional reciprocating tachycardia in infants and Children

Taking Time With the RP Interval in Narrow Complex Tachycardia

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