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The response to entrainment from the right ventricular apex (RVA) is useful to distinguish typical AV node reentrant tachycardia (AVNRT) from atrio-ventricular reentrant tachycardia (AVRT). The purpose of this study was to determine whether this response is useful for differentiating fast-slow AVNRT from the permanent form of junctional reciprocating tachycardia (PJRT).Methods: We studied 33 patients (P) with fast-slow AVNRT or PJRT with successful entrainment from the RVA. All tachycardias had a VA interval which was longer than the AV interval. Diagnoses of fast-slow AVNRT or PJRT were made according to conventional electrophysiological criteria and confirmed by the outcome of the ablation. Fifteen P (mean age 55±24 years, 6 males, tachycardia cycle length -TCL- 446±72 ms) had fast-slow AVNRT, and 18 P (mean age 41±22 years, 10 males, TCL 353±59 ms) had PJRT. The following responses to entrainment were analysed: difference between the postpacing interval after entrainment and TCL (PPI-TCL), difference between the Stimulus-Atrial electrogram interval during entrainment and the VA interval during tachycardia (SA-VA interval), and the A-V response upon cessation of ventricular overdrive pacing (A-V versus pseudo A-A-V response). Optimal cut-off values of continuous variables were determined by ROC curve analyses.Results: Significant differences in mean values for SA-VA interval, PPI-TCL and A-V responses were observed between the two groups (table). The diagnostic yield of the selected cut-off values is also shown. For PPI-TCL: area under ROC curve 0.85; p=0.01. For SA-VA: area under ROC curve: 0.9; p=0.004.View this table:Table 1Conclusions: The response to tachycardia entrainment from the RVA is useful in order to distinguish fast-slow AVNRT from PJRT. A PPI-TCL lower than 130 ms and an SA-VA interval lower than 100 ms are highly suggestive of PJRT and make fast-slow AVNRT unlikely.

Entrainment from the right ventricle distinguishes fast-slow AV nodal reentrant tachycardia from permanent junctional reciprocating tachycardia