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- Title
'V-H-A Pattern' as a Criterion for the Differential Diagnosis of Atypical AV Nodal Reentrant Tachycardia from AV Reciprocating Tachycardia.
- Authors
Owada S; Iwasa A; Sasaki S; Higuma T; Kimura M; Kobayashi T; Ashikaga K; Okumura K
- Abstract
OWADA, S., et al.: 'V-H-A Pattern' as a Criterion for the Differential Diagnosis of Atypical AV Nodal Reentrant Tachycardia from AV Reciprocating Tachycardia . Background: During ventricular extrastimulation, His bundle potential (H) following ventricular (V) and followed by atrial potentials (A), i.e., V-H-A, is observed in the His bundle electrogram when ventriculo-atrial (VA) conduction occurs via the normal conduction system. We examined the diagnostic value of V-H-A for atypical form of atrioventricular nodal reentrant tachycardia (AVNRT), which showed the earliest atrial activation site at the posterior paraseptal region during the tachycardia. Methods: We prospectively examined the response of VA conduction to ventricular extrastimulation during basic drive pacing performed during sinus rhythm in 16 patients with atypical AVNRT masquerading atrioventricular reciprocating tachycardia (AVRT) utilizing a posterior paraseptal accessory pathway and 21 with AVRT utilizing a posterior paraseptal accessory pathway. Long RP' tachycardia with RP'/RR > 0.5 was excluded. The incidences of V-H-A and dual AV nodal physiology (DP) were compared between atypical AVNRT and AVRT. Results: V-H-A was demonstrated in all the 16 patients (100%) in atypical AVNRT and in only 1 of the 21 (5%) in AVRT (P < 0.001). DP was demonstrated in 10 patients (63%) in atypical AVNRT and in 4 (19%) in AVRT (P < 0.05). The sensitivity of V-H-A for atypical AVNRT was higher than that of DP (P < 0.05). Positive and negative predictive values were 94% and 100%, respectively, for V-H-A and 71% and 74%, respectively, for DP. Conclusions: The appearance of V-H-A during ventricular extrastimulation is a simple criterion for differentiating atypical AVNRT masquerading AVRT from AVRT utilizing a posterior paraseptal accessory pathway. (PACE 2005; 28:667-674)
- Publication
Pacing & Clinical Electrophysiology, 2005, Vol 28, Issue 7, p667
- ISSN
0147-8389
- Publication type
Journal Article
- DOI
10.1111/j.1540-8159.2005.00151.x