Slow pathway modification in patients presenting with only two consecutive AV nodal echo beats

Wegner, Felix K.; Silvano, Maria; Bögeholz, Nils; Leitz, Patrick; Frommeyer, Gerrit; Dechering, Dirk G.; Zellerhoff, Stephan; Kochhäuser, Simon; Lange, Philipp; Köbe, Julia; Wasmer, Kristina; Mönnig, Gerold; Eckardt, Lars; Pott, Christian

doi:10.1016/j.jjcc.2016.02.011

Cited by 7 publications

(16 citation statements)

References 18 publications

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“…As additional preconditions, they also had to exhibit either dual AVN physiology or an ECG documentation consistent with AVNRT, or both of these features, and they had to exhibit relevant symptoms. These conditions are similar to the requirements of other studies that have performed empirical slow pathway modulation . We did not use RF delivery in the slow pathway region as a purely diagnostic tool.…”

Section: Discussionmentioning

confidence: 79%

“…Out of these, one had received a slow pathway modulation due to inducible AVNRT. The 13 patients presented in this study were part of the populations of two previous studies from our group investigating characteristics and success rates of empirical slow pathway modulation . However, these studies did not specifically analyze in detail those patients in whom AVNRT occurred during or after RF delivery.…”

Section: Methods and Resultsmentioning

confidence: 99%

“…Details of the procedures have been reported previously . The EPS including RF delivery had a mean duration of 122 ± 11 min.…”

Section: Methods and Resultsmentioning

confidence: 99%

“…The residual occurrence of an AH jump and/or of one AV nodal echo was tolerated after RF delivery, because slow pathway modulation and not slow pathway ablation was intended. All other procedural aspects including catheter placement and mapping of the slow pathway region were conducted as previously reported . No severe complications requiring further treatment occurred.…”

Section: Methods and Resultsmentioning

confidence: 99%

“…If induction is achieved, the therapy of choice is a catheter‐based modulation of the slow pathway of the atrioventricular (AV) node. If induction is impossible despite thorough programmed atrial stimulation with and without pharmacological provocation (eg, orciprenaline or atropine), an empirical radiofrequency (RF) impulse delivery may be considered if dual AV nodal physiology and/or a characteristic electrocardiogram (ECG) documentation are present . However, during RF delivery, the patient is exposed to complications such as complete AV block.…”

Section: Introductionmentioning

confidence: 99%

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Occurrence of primarily noninducible atrioventricular nodal reentry tachycardia after radiofrequency delivery in the slow pathway region during empirical slow pathway modulation

Wegner

Bögeholz

Leitz

et al. 2017

Clinical Cardiology

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Background The first‐line therapy for atrioventricular nodal reentry tachycardia (AVNRT) is catheter‐based slow pathway modulation. If AVNRT is not inducible during an electrophysiological study, an empirical slow pathway modulation (ESPM) may be considered in patients with dual atrioventricular nodal physiology and/or a typical electrocardiogram (ECG). Methods We screened 149 symptomatic patients who underwent ESPM in our department between 1993 and 2013. All patients fulfilled the following criteria: (1) either dual atrioventricular nodal (AVN) physiology with up to 2 AVN echo beats or characteristic ECG documentation or both, (2) noninducibility of AVNRT by programmed stimulation, and (3) completion of a telephone questionnaire for long‐term follow‐up. Out of this population we retrospectively investigated 13 patients who were primarily noninducible but in whom an AVNRT occurred during or after radiofrequency (RF) delivery. Results When AVNRT occurred, the procedure lost its empirical character, and RF delivery was continued until the procedural endpoint of noninducibility of AVNRT. This endpoint was reached in all but one patient (92%). After a follow‐up of 73 ± 15 months, this patient was the only one who reported no benefit from the procedure. Conclusions Out of 149 initially noninducible patients, a considerable number (9%) exhibited AVNRT during or after RF delivery. These patients crossed over from empirical to controlled slow pathway modulation resulting in a good clinical outcome. Our observations should encourage electrophysiologists to repeat programmed stimulation even after initial empirical RF delivery to retest for inducibility.

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Section: Discussionmentioning

confidence: 79%

Section: Methods and Resultsmentioning

confidence: 99%

“…Details of the procedures have been reported previously . The EPS including RF delivery had a mean duration of 122 ± 11 min.…”

Section: Methods and Resultsmentioning

confidence: 99%

Section: Methods and Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Occurrence of primarily noninducible atrioventricular nodal reentry tachycardia after radiofrequency delivery in the slow pathway region during empirical slow pathway modulation

Wegner

Bögeholz

Leitz

et al. 2017

Clinical Cardiology

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Prospective blinded evaluation of smartphone-based ECG for differentiation of supraventricular tachycardia from inappropriate sinus tachycardia

et al. 2021

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Introduction Supraventricular tachycardias (SVT) are often difficult to document due to their intermittent, short-lasting nature. Smartphone-based one-lead ECG monitors (sECG) were initially developed for the diagnosis of atrial fibrillation. No data have been published regarding their potential role in differentiating inappropiate sinus tachycardia (IST) from regular SVT. If cardiologists could distinguish IST from SVT in sECG, economic health care burden might be significantly reduced. Methods We prospectively recruited 75 consecutive patients with known SVT undergoing an EP study. In all patients, four ECG were recorded: a sECG during SVT and during sinus tachycardia and respective 12-lead ECG. Two experienced electrophysiologists were blinded to the diagnoses and separately evaluated all ECG. Results Three hundred individual ECG were recorded in 75 patients (47 female, age 50 ± 18 years, BMI 26 ± 5 kg/m2, 60 AVNRT, 15 AVRT). The electrophysiologists’ blinded interpretation of sECG recordings showed a sensitivity of 89% and a specificity of 91% for the detection of SVT (interobserver agreement κ = 0.76). In high-quality sECG recordings (68%), sensitivity rose to 95% with a specificity of 92% (interobserver agreement of κ = 0.91). Specificity increased to 96% when both electrophysiologists agreed on the diagnosis. Respective 12-lead ECG had a sensitivity of 100% and specificity of 98% for the detection of SVT. Conclusion A smartphone-based one-lead ECG monitor allows for differentiation of SVT from IST in about 90% of cases. These results should encourage cardiologists to integrate wearables into clinical practice, possibly reducing time to definitive diagnosis of an arrhythmia and unnecessary EP procedures. Graphical abstract A smartphone-based one lead ECG device (panel A) can be used reliably to differentiate supraventricular tachycardia (panel B) from inappropriate sinus tachycardia when compared to a simultaneously conducted gold-standard electrophysiology study (panels C, D).

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Value of an old school approach: safety and long-term success of radiofrequency current catheter ablation of atrioventricular nodal reentrant tachycardia in children and young adolescents

Siebels¹,

Sohns²,

Nürnberg³

et al. 2018

J Interv Card Electrophysiol

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Slow pathway modification in patients presenting with only two consecutive AV nodal echo beats

Cited by 7 publications

References 18 publications

Occurrence of primarily noninducible atrioventricular nodal reentry tachycardia after radiofrequency delivery in the slow pathway region during empirical slow pathway modulation

Occurrence of primarily noninducible atrioventricular nodal reentry tachycardia after radiofrequency delivery in the slow pathway region during empirical slow pathway modulation

Prospective blinded evaluation of smartphone-based ECG for differentiation of supraventricular tachycardia from inappropriate sinus tachycardia

Value of an old school approach: safety and long-term success of radiofrequency current catheter ablation of atrioventricular nodal reentrant tachycardia in children and young adolescents

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