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“V‐H‐A Pattern” as a Criterion for the Differential Diagnosis of Atypical AV Nodal Reentrant Tachycardia from AV Reciprocating Tachycardia
Author(s) -
OWADA SHINGEN,
IWASA ATSUSHI,
SASAKI SHINGO,
HIGUMA TAKUMI,
KIMURA MASAOMI,
KOBAYASHI TAKAO,
ASHIKAGA KEIICHI,
OKUMURA KEN
Publication year - 2005
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.1540-8159.2005.00151.x
Subject(s) - medicine , tachycardia , cardiology , accessory pathway , nodal , catheter ablation , ablation
Background: During ventricular extrastimulation, His bundle potential (H) following ventricular (V) and followed by atrial potentials (A), i.e., V‐H‐A, is observed in the His bundle electrogram when ventriculo‐atrial (VA) conduction occurs via the normal conduction system. We examined the diagnostic value of V‐H‐A for atypical form of atrioventricular nodal reentrant tachycardia (AVNRT), which showed the earliest atrial activation site at the posterior paraseptal region during the tachycardia.Methods: We prospectively examined the response of VA conduction to ventricular extrastimulation during basic drive pacing performed during sinus rhythm in 16 patients with atypical AVNRT masquerading atrioventricular reciprocating tachycardia (AVRT) utilizing a posterior paraseptal accessory pathway and 21 with AVRT utilizing a posterior paraseptal accessory pathway. Long RP' tachycardia with RP'/RR > 0.5 was excluded. The incidences of V‐H‐A and dual AV nodal physiology (DP) were compared between atypical AVNRT and AVRT.Results: V‐H‐A was demonstrated in all the 16 patients (100%) in atypical AVNRT and in only 1 of the 21 (5%) in AVRT (P < 0.001). DP was demonstrated in 10 patients (63%) in atypical AVNRT and in 4 (19%) in AVRT (P < 0.05). The sensitivity of V‐H‐A for atypical AVNRT was higher than that of DP (P < 0.05). Positive and negative predictive values were 94% and 100%, respectively, for V‐H‐A and 71% and 74%, respectively, for DP.Conclusions: The appearance of V‐H‐A during ventricular extrastimulation is a simple criterion for differentiating atypical AVNRT masquerading AVRT from AVRT utilizing a posterior paraseptal accessory pathway.