A novel pacing maneuver to verify the postpacing interval minus the tachycardia cycle length while adjusting for decremental conduction: Using 'dual-chamber entrainment' for improved supraventricular tachycardia discrimination
| Autor: | L. Bing Liem, Scott R. Ceresnak, Javed M. Nasir, Kara S. Motonaga, Daniel W. Kaiser, Chad Brodt, Mintu P. Turakhia, Anne M. Dubin |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Tachycardia medicine.medical_specialty Decremental conduction Adolescent medicine.medical_treatment Catheter ablation 030204 cardiovascular system & hematology Article Intracardiac injection Diagnosis Differential 03 medical and health sciences 0302 clinical medicine Heart Conduction System Physiology (medical) Internal medicine Tachycardia Reciprocating Tachycardia Supraventricular medicine Humans Tachycardia Atrioventricular Nodal Reentry 030212 general & internal medicine Cycle length business.industry Reproducibility of Results medicine.disease Dimensional Measurement Accuracy Catheter Ablation Cardiology Female Supraventricular tachycardia medicine.symptom Electrophysiologic Techniques Cardiac Cardiology and Cardiovascular Medicine business Entrainment (chronobiology) Orthodromic |
| Zdroj: | Heart Rhythm |
| ISSN: | 1547-5271 |
| Popis: | BACKGROUND: The postpacing interval (PPI) minus the tachycardia cycle length (TCL) is frequently used to investigate tachycardias. However, a variety of issues (eg, failure to entrain, decremental conduction, and oscillating TCLs) can make interpretation of the PPI–TCL challenging. OBJECTIVE: The purpose of this study was to investigate a novel maneuver to confirm the PPI–TCL value without using either the ventricular PPI or the TCL interval and to assess the ability of this maneuver to identify decremental conduction and differentiate supraventricular tachycardias. METHODS: We analyzed 77 intracardiac recordings from patients (age 25 ± 20 years; 40 female) who underwent catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) or orthodromic reciprocating tachycardia (ORT) with a concealed pathway. We calculated the PPI–TCL, the AH-corrected PPI–TCL, and estimated the PPI–TCL using “dual-chamber entrainment” calculated as [PPI(V) − TCL = Stim(A→V) + Stim(V→A) − PPI(A)]. RESULTS: The PPI–TCL calculated by dual-chamber entrainment highly correlated with the observed and AH-corrected PPI–TCL (R(2) = 0.79 and 0.96, respectively; P 10 ms) decrement. CONCLUSION: Dual-chamber entrainment estimates the PPI–TCL value without using either the ventricular PPI or the TCL interval. This maneuver adjusts for all decremental conduction, including within concealed pathways, where a dual-chamber entrainment PPI–TCL value >80 ms favors AVNRT over ORT. This maneuver can be used to verify the observed PPI–TCL value in challenging cases. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|