Mechanisms of Transition Between Double Paroxysmal Supraventricular Tachycardias

Kuo, Jen‐Yuan; Tai, Ching‐Tai; Chiang, Chern‐En; Yu, Wen‐Chung; Chen, Yi Jen; Tsai, Chin‐Feng; Hsieh, Ming‐Hsiung; Chen, Chien‐Cheng; Lin, Wei‐Shiang; Lin, Yung‐Kuo; Tsao, Hsuan‐Ming; Ding, Yu‐An; Chang, Mau‐Song; Chen, Shih‐Ann

doi:10.1046/j.1540-8167.2001.01339.x

Cited by 35 publications

(38 citation statements)

References 2 publications

(2 reference statements)

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“…These data support the view that, during ablation of persistent AF, ATs of different mechanism and substrate are observed and many are arguably contemporaneous. The presence of double tachycardia has obviously been demonstrated in other contexts 8–14 . These data are consistent with the complexity of persistent AF that is clearly involved with a diffuse arrhythmogenic substrate and multiple potential “sources” of tachycardia.…”

Section: Resultssupporting

confidence: 77%

Tachycardia Transition During Ablation of Persistent Atrial Fibrillation

Arantès¹,

Klein²,

Jaı̈s³

et al. 2010

Journal of Cardiovascular Electrophysiology

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Transition to a second AT occurs frequently in the midst of ablation of AT in persistent AF patients. This transition occurs most commonly abruptly within the range of a single cycle length of the original AT. This is best explained by a continuation of AT that was "present" simultaneously with the pretransition tachycardia, being "entrained" (for a reentrant tachycardia) or "overdriven" for an automatic focal tachycardia. The presence of multiple tachycardia mechanisms active simultaneously would be consistent with the eclectic pathophysiology of persistent AF.

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Section: Resultssupporting

confidence: 77%

Tachycardia Transition During Ablation of Persistent Atrial Fibrillation

Arantès¹,

Klein²,

Jaı̈s³

et al. 2010

Journal of Cardiovascular Electrophysiology

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“…Dual tachycardias in the same patient were first described in 1920 1 . Kuo et al 2 in a retrospective study of the electrophysiologic properties of double supraventricular tachycardias (SVT) reported an incidence of 2.6% in their laboratory. In the 35 patients studied, transition between two SVTs was due to spontaneous APB in 30%, conduction block at one limb of tachycardia in 20%, and tachycardia‐induced tachycardia in 50%.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to be alert to the possibility of double tachycardia during ablation procedure as switch from one tachycardia to other creates confusion and can lead to suboptimal outcome of the procedure 3 . Other than the similarity of the tachycardia CL, arrhythmogenic site of different SVT may affect spontaneous transition 2 …”

Section: Discussionmentioning

confidence: 99%

Tachycardias: One or Two?

Toal

Harris

Ing

2006

Cardiovasc electrophysiol

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A 71-year-old patient presented with a 3-year history of paroxysmal, rapid regular palpitations despite trials of sotalol and diltiazem. A previous Holter study had documented a narrow QRS tachycardia (Fig. 1). The patient underwent an electrophysiology study (EPS) during which a tachycardia was inducible with programmed atrial stimulation (Fig. 2). What is the diagnosis?The Holter rhythm strips A and B (Fig. 1) document a narrow QRS tachycardia. The tachycardia is initiated by an atrial premature beat (APB) (third beat in Panel I) without a P wave to R wave interval (PR) jump. After the first four cycles, atrial but not ventricular activity becomes regular. The irregularity in RR cycle length (CL) persists until the end of Panel II, at which time it too becomes regular. The CL of the tachycardia in Panel III is 340 msec (shorter than in Panel II by 20 msec). The relationship between the ventricular and atrial excitation is not constant in Panels I and II. In Panel III, there is a constant and short RP relationship favoring atrioventricular nodal reentrant tachycardia (AVNRT). The irregularity in the RP relationship in Panels I and II could potentially be explained by AVNRT with variable block to the ventricle. An alternative explanation would be an atrial Figure 1. Holter strips A and B showing initiation of tachycardia in Panel I.tachycardia initiated by an APB without a PR jump exhibiting variable conduction to the ventricles initially (Panels I and II) but later stabilizing to 1:1 conduction (Panel III). Analyzing Figure 1 further reveals a change in the morphology of the QRS, clearly seen in the "B" rhythm strip, in the first two as well as the last three complexes of Panel II and throughout Panel III. This raises the suspicion of two tachycardias, the initiation being an atrial tachycardia (Panel I) that transforms by the end of Panel II into an AVNRT. The tachycardia in Panels I and II cannot be AVRT because of the varying R and P relationship. In Panel III, the RP relationship becomes constant, but the short RP interval makes a diagnosis of AVRT unlikely.At EPS, the arrhythmia induced is also a narrow QRS tachycardia at CL of 315 msec (Fig. 2). Though there is no significant change in the CL, from the fourth QRS complex onward subtle changes in QRS morphology are apparent. The intracardiac recording of Figure 3 reveals that the first three beats have the earliest local activation in the high right atrium, suggesting the mechanism to be atrial tachycardia (the short Figure 2. 12-Lead surface ECG of tachycardia initiated at EPS.

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“…Details of the electrophysiological study have been described previously (10). In brief, the diagnostic portion of the electrophysiological study included: (i) measurement of the electrical properties of the atrium, AV node, ventricle, and accessory pathways; (ii) induction of supraventricular tachycardia; and (iii) determination of the mechanism of tachycardia.…”

Section: Electrophysiological Test and Radiofrequency Ablationmentioning

confidence: 99%

“…The maximal preset temperature was 708C in every patient with AVRT, or 608C in patients with AT or AVNRT. The ablation techniques used in various types of tachycardias have been described previously (10).…”

Section: Electrophysiological Test and Radiofrequency Ablationmentioning

confidence: 99%