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Diagnostic Value of Comparison of Ventriculoatrial Interval During Junctional Tachycardia and Right Ventricular Apical Pacing
Author(s) -
CROZIER IAN,
WAFA SAMIR,
WARD DAVID,
CAMM JOHN
Publication year - 1989
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1989.tb05032.x
Subject(s) - medicine , tachycardia , cardiology , atrioventricular reentrant tachycardia , ventricular tachycardia , electrocardiography , accessory pathway , anesthesia , catheter ablation , atrial fibrillation
We postulated that comparison of ventriculoatrial intervals during junctional tachycardia and during right ventricular apical pacing may provide similar diagnostic information to that obtained from the insertion of ventricular extrasystoles during tachycardia. We studied 39 patients with either atrioventricular reentrant tachycardia (AVRT) (23 patients) using a single atrioventricular accessory pathway or atrioventricular nodal reentrant tachycardia (AVNRT) (16 patients). Ventriculoatrial [VA] intervals were measured during tachycardia, during right ventricular apical pacing at the same rate as that of the tachycardia and following a ventricular extrasystole delivered at the minimum reset interval (minimum prematurity of a ventricular extrasystole required to advance the subsequent atrial complex by more than 10 msec). The difference between the minimum VA interval during tachycardia and during ventricular pacing was closely related to both the minimum reset interval (r = 0.92, P < 0.001) and the difference between the minimum VA interval during tachycardia and following a ventricular extrasystole delivered at the minimum reset interval (r = 0.97, P < 0.001) in the 23 patients in whom the minimum reset interval could be determined. The ratio between the minimum Ventriculoatrial interval during tachycardia and ventricular pacing could be determined in all cases and was between 1.53 and 1.68 in AVRT with right free wall (two patients), 0.94 and 1.29 with anteroseptal (three patients), 0.91 and 1.08 with posteroseptal (five patients) and 0.48 and 0.71 with left free wall (13 patients) pathways, while it was between 0.32 and 0.27 in AVNRT (16 patients). The ratio was more discriminative when corrected for ventricular latency and was also useful when calculated from the high right atrial electrogram. We concluded that comparison of Ventriculoatrial intervals during junctional tachycardia and during right ventricular apical pacing can discriminate between the mechanisms of tachycardia and the site of pathway. It provides similar information to that obtained from ventricular extrasystoles during tachycardia with the advantage that it can be determined in all cases.