Premium
Prospective Evaluation Of The Length Of The Lower Common Pathway In The Differential Diagnoss Of Various Forms Of AV Nodal Reentrant Tachycardia
Author(s) -
HEIDBÜCHEL HEIN,
ECTOR HUGO,
WERF FRANS
Publication year - 1998
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.1540-8159.1998.tb01090.x
Subject(s) - medicine , tachycardia , nodal , reentrancy , cardiology , prospective cohort study , computer science , programming language
The conduction time over the lower common pathway (LCP) in AVNRT can be assessed by subtracting the H A‐interval during tachycardia (HA t ) from that during ventricular pacing at exactly the same cycle length (HAp) (ΔHA = HAp ‐ HAt). tt has been suggested that H‐A measurements may help in the differentiation of Slow/Fast from Slow/Slow AVNRT. This study evaluated prospectively in 61 consecutive patients with AVNRT (43 ± 15 y; 46 women, all with antegrade conduction during AVNRT over the slaw pathway) how often a reliable measurement of the length of the LCP could be made, and in how far the results were concordant with mapping criteria for the differentiation of Slow/Fast from Slow/Slow A VNRT. A new para‐Hisian pacing technique (using only the His bundle catheter) was applied in all patients. Comparison of HAt and HAp was possible in 44 of the 61 patients (72%). In these 44 patients, HAp was longer than HAt in 12 patients, indicating the presence of a LCP. All patients with ΔHA ≥ 15 ms had earliest retrograde atrial activation in the posterior septum (Slow/Slow AVNRT, n = 6) or simultaneously in the anterior and posterior septum (n = 1). On the other hand, 31 of the 32 patients without evidence of a substantial LCP (ΔHA ≤ 0) had typical Slow/Fast AVNRT. Moreover, although it appears logical for Slow/Fast A VNRT to have a shorter HAt than Slow'Slow A VNRT, an HAp of ≥ 70 ms was a better discriminator between the two forms of AVNRT than any HAt value. Therefore, ΔHA ≥ 15 ms (sens. ≥86%; spec. ≥97%) or HAp ≥ 70 ms (sens. = 100%; spec. ≥89%) were highly indicative for the Slow/Slow variant of AVNRT. Using a para‐Hisian pacing technique, H‐A measurements can be performed in 72% of A VNRT patients. They can be used as an important tool in the differentiation of Slow/Fast and Slow/Slow A VNRT.