When and how does a single ventricular premature beat initiate and terminate supraventricular tachycardia?

Abstract

Background:The differential diagnosis of a supraventricular tachycardia (SVT) is accomplished using a number of pacing maneuvers. The incidence and mechanism of a single ventricular premature beat (VPB) on initiation and termination of tachycardia were evaluated during programmed electrical stimulation (PES) of the heart in patients with the two most common regular SVTs: atrioventricular re-entrant tachycardia (AVNRT) and orthodromic atrioventricular tachycardia (AVRT). Methods:Three hundred and thirty-seven consecutive patients aged above 18 years with an inducible sustained AVNRT or AVRT were prospectively enrolled. Patients with more than one tachyarrhythmia mechanism were excluded. Two hundred and seventeen patients (64.4%) had typical slow/fast AVNRT and 120 (35.6%) had an orthodromic AVRT using a rapidly conducting accessory pathway for V-A conduction.In this cross-sectional study, we specifically report the analysis of tachycardia induction and termination by a single VPB.Results: Tachycardia induction with a single VPB during sinus rhythm was seen in 7 of 120 AVRT and in only one of the 217 patients with AVNRT, (5.8% vs. 0.3%, p < 0.05). When a single VPB was delivered during basic ventricular pacing these values were 28% versus 4%, respectively, (p < 0.001). Termination of tachycardia by a single VPB was observed in nine (4.1%) patients with AVNRT and in 57 (47.5%) with AVRT (p < 0.001).Conclusion: Initiation of SVT by a single VPB during sinus rhythm was uncommon and favored AVRT. Termination of SVT by a single VPB was commonly seen in AVRT but rarely in AVNRT. These findings can be of help when interpreting a noninvasive arrhythmia event recording. K E Y W O R D Scardiac rhythm event recorders, electrophysiologic study, supraventricular tachycardia, tachycardia mechanisms

Uncommon modes of initiation of ‘A on V’ narrow QRS tachycardia: What are the mechanisms?

“…Typical AVNRT is usually inducible by atrial pacing maneuvers and uncommonly by VES 1 . Rarely, typical AVNRT can be induced only by VES and can be explained by the two different mechanisms as explained in this case.…”

Two tachycardias, wide and narrow‐more than a coincidence?

“…They found that while initiation of orthodromic atrioventricular reentrant tachycardia occurred in 34/120 (28.3%) patients by a single ventricular premature beat, initiation of typical AVNRT was observed in only 8/217 (3.6%) patients (P < .001). However, AVNRT initiation by a burst from the right ventricle is more common, because consecutive beats can more easily get into the A-V node, and was seen in 18 out of 217 (8.2%) patients (1). In this case, the QRS morphology during VT suggests activation originating in the apical part of the septum which may have facilitated retrograde impulse conduction up into the His-Purkinje system.…”