A simplified approach for evaluating sustained slow pathway conduction for diagnosis and treatment of atrioventricular nodal reentry tachycardia in children and adults
| Autor: | Michał Labus, Aleksandra Swietoniowska-Mscisz, Karol Deutsch, Lesław Szydłowski, Sebastian Stec, Monika Klank-Szafran, Bartosz Ludwik, Janusz Sledz, Tomasz Kameczura, Mariusz Mazij, Adrian Mscisz, Dariusz Karbarz, Jerzy Spikowski, Aleksandra Morka, Jacek Kusa |
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| Rok vydání: | 2017 |
| Předmět: |
Tachycardia
Adult Male medicine.medical_specialty Slow pathway medicine.medical_treatment 030204 cardiovascular system & hematology QT interval Nodal disease 03 medical and health sciences Electrocardiography 0302 clinical medicine Heart Conduction System Internal medicine Medicine Humans Tachycardia Atrioventricular Nodal Reentry 030212 general & internal medicine PR interval Child Coronary sinus business.industry Surrogate endpoint Coronary Sinus General Medicine Ablation Case-Control Studies Cardiology Female medicine.symptom business |
| Zdroj: | Advances in medical sciences. 63(2) |
| ISSN: | 1898-4002 |
| Popis: | During incremental atrial pacing in patients with atrioventricular nodal reentrant tachycardia, the PR interval often exceeds the RR interval (PR RR) during stable 1:1 AV conduction. However, the PR/RR ratio has never been evaluated in a large group of patients with pacing from the proximal coronary sinus and after isoproterenol challenge. Our study validates new site of pacing and easier method of identification of PR RR.A prospective protocol of incremental atrial pacing from the proximal coronary sinus was carried out in 398 patients (AVNRT-228 and control-170). The maximum stimulus to the Q wave interval (S-Q = PR), SS interval (S-S), and Q-Q (RR) interval were measured at baseline and 10 min after successful slow pathway ablation and after isoproterenol challenge (obligatory).The mean maximum PR/RR ratios at baseline were 1.17 ± 0.24 and 0.82 ± 0.13 (p 0.00001) in the AVNRT and controls respectively. There were no PR/RR ratios ≥1 at baseline and after isoproterenol challenge in 12.3% of the AVNRT group and in 95.9% of the control group (p 0.0001). PR/RR ratios ≥1 were absent in 98% of AVNRT cases after slow pathway ablation/modification in children and 99% of such cases in adults (P = NS). The diagnostic performance of PR/RR ratio evaluation before and after isoproterenol challenge had the highest diagnostic performance for AVNRT with PR/RR = 1 (sensitivity: 88%, specificity: 96%, PPV-97%, NPV-85%).The PR/RR ratio is a simple tool for slow pathway substrate and AVNRT evaluation. Eliminating PR/RR ratios ≥1 may serve as a surrogate endpoint for slow pathway ablation in children and adults with AVNRT. |
| Databáze: | OpenAIRE |
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