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His overdrive pacing during supraventricular tachycardia: A novel maneuver for distinguishing atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia
- Source :
- Heart Rhythm. 11:1327-1335
- Publication Year :
- 2014
- Publisher :
- Elsevier BV, 2014.
-
Abstract
- Background Because the His bundle is intrinsic to the circuit in orthodromic reciprocating tachycardia and remote from that of atrioventricular nodal reentrant tachycardia (AVNRT), pacing the His bundle during supraventricular tachycardia (SVT) may be useful to distinguish these arrhythmias. Objective The purpose of this study was to test the hypothesis that His overdrive pacing (HOP) would affect SVT immediately for orthodromic reciprocating tachycardia and in a delayed manner for AVNRT. Methods Once SVT was induced, HOP was performed by pacing the His bundle 10–30 ms faster than the SVT cycle length. The maneuver was determined to have entered the tachycardia circuit when a nonfused His-capture beat advanced or delayed the subsequent atrial electrogram by ≥10 ms or when the tachycardia was terminated. The number of beats required to enter each tachycardia with HOP was recorded. Results HOP was performed during 66 SVTs (26 atrioventricular reciprocating tachycardia [AVRT] and 40 AVNRT). Entry into the tachycardia within 1 beat had sensitivity of 92%, specificity of 92%, positive predictive value (PPV) of 89% and negative predictive value (NPV) of 95% to confirm the diagnosis of AVRT. A cutoff ≥3 beats to enter the circuit had sensitivity of 90%, specificity of 92%, PPV of 95% and NPV of 86% to confirm the diagnosis of AVNRT. HOP had sensitivity, specificity, PPV, and NPV of 100% for distinguishing septal AVRT from atypical AVNRT. Conclusion HOP during SVT is a novel technique for distinguishing orthodromic reciprocating tachycardia from AVNRT. It can reliably distinguish between these arrhythmias with high sensitivity and specificity.
- Subjects :
- Adult
Male
Tachycardia
Novel technique
Bundle of His
medicine.medical_specialty
Adolescent
Accessory pathway
Diagnosis, Differential
Electrocardiography
Young Adult
Reciprocating motion
Heart Conduction System
Physiology (medical)
Internal medicine
Tachycardia, Reciprocating
medicine
Humans
Tachycardia, Atrioventricular Nodal Reentry
cardiovascular diseases
Cycle length
Retrospective Studies
business.industry
Cardiac Pacing, Artificial
medicine.disease
Predictive value
Anesthesia
cardiovascular system
Cardiology
Female
Supraventricular tachycardia
medicine.symptom
Electrophysiologic Techniques, Cardiac
Cardiology and Cardiovascular Medicine
business
Orthodromic
Follow-Up Studies
Subjects
Details
- ISSN :
- 15475271
- Volume :
- 11
- Database :
- OpenAIRE
- Journal :
- Heart Rhythm
- Accession number :
- edsair.doi.dedup.....4fadc53725a6c5685b1c5fab8375d1a4