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- Title
Differences in Ventriculoatrial Intervals During Entrainment and Tachycardia: A Simpler Method for Distinguishing Paroxysmal Supraventricular Tachycardia with Long Ventriculoatrial Intervals.
- Authors
GONZÁLEZ‐TORRECILLA, ESTEBAN; ALMENDRAL, JESÚS; GARCÍA‐FERNÁNDEZ, FRANCISCO J.; ARIAS, MIGUEL A.; ARENAL, ANGEL; ATIENZA, FELIPE; DATINO, TOMÁS; ATEA, LEONARDO F.; CALVO, DAVID; PACHÓN, MARTA; FERNÁNDEZ‐AVILÉS, FRANCISCO
- Abstract
VA Intervals to Distinguish PSVT. Introduction: Usefulness of the interval between the last pacing stimulus and the last entrained atrial electrogram (SA) minus the tachycardia ventriculoatrial (VA) interval in the differential diagnosis of supraventricular tachycardias with long (>100 ms) VA intervals has not been prospectively studied in a large series of patients. Our objective was to assess the usefulness of the difference SA-VA in diagnosing the mechanism of those tachycardias in patients without preexcitation. The results were compared with those obtained using the corrected return cycle (postpacing interval-tachycardia cycle length-atrioventricular [AV] nodal delay). Methods and Results: We included 314 consecutive patients with inducible sustained supraventricular tachycardias with VA intervals >100 ms undergoing an electrophysiologic study. Atrial tachycardias were excluded. Tachycardia entrainment was attempted through pacing trains from right ventricular apex. The SA-VA difference and the corrected return cycle were calculated for every patient. Electrophysiologic study revealed 82 atypical AV nodal reentrant tachycardias (AVNRT) and 237 AV reentrant tachycardias (AVRT) using septal (n = 91) or free-wall (n = 146) accessory pathways (APs). A SA-VA difference >110 ms identified an atypical AVNRT with sensitivity, specificity, positive and negative predictive values of 99%, 98%, 95%, and 99.5%, respectively. Similarly, these values were 88%, 83%, 77%, and 92% for SA-VA difference <50 ms in identifying AVRT through a septal versus free-wall AP. The SA-VA difference showed higher accuracy in septal AP identification than that obtained using the corrected return cycle. Conclusion: The difference SA-VA provides a simpler electrophysiologic maneuver that reliably differentiates atypical AVNRT from AVRT regardless of concealed AP location. (J Cardiovasc Electrophysiol, Vol. 22, pp. 915-921, August 2011)
- Subjects
TACHYCARDIA diagnosis; ANALYSIS of variance; ATRIOVENTRICULAR node; COMPUTER software; CONFIDENCE intervals; DIFFERENTIAL diagnosis; ELECTROPHYSIOLOGY; FISHER exact test; HEART atrium; STATISTICS; T-test (Statistics); TACHYCARDIA; DATA analysis; RECEIVER operating characteristic curves; DIAGNOSIS
- Publication
Journal of Cardiovascular Electrophysiology, 2011, Vol 22, Issue 8, p915
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/j.1540-8167.2011.02020.x