TY - JOUR
T1 - Atrial Premature Beats During Decrementally Conducting Antidromic Tachycardia
AU - Sternick, Eduardo Back
AU - Lokhandwala, Yash
AU - Timmermans, Carl
AU - Gerken, Luiz
AU - Soares, Frederico
AU - Dias, Liana
AU - Huo, Yan
AU - Hindricks, Gerhard
AU - Wellens, Hein J. J.
PY - 2013/4
Y1 - 2013/4
N2 - Background-Advancement of ventricular activation by an atrial premature beat (APB) given during His bundle refractoriness followed by resetting of an antidromic tachycardia (AT) in patients with decrementally conducting accessory pathway (DAP) is a helpful maneuver to prove pathway existence and participation in the circuit. We aim to assess in a large cohort the role of APB during AT in patients with a DAP. Methods and Results-Thirty-three patients with a DAP having 34 AT were included in the study: 29 patients had an atriofascicular pathway, 1 had a long atrioventricular DAP, and 4 had a short atrioventricular fiber. APBs were delivered initially from the lateral right atrium, scanning diastole with a 10-ms decrement until AT termination or refractoriness. We observed 4 patterns of response after APB during AT: advancement of activation (29 cases), delay (2), advancement followed by delay (3), and termination (7). Eight patients required an earlier APB to advance or delay ventricular activation. These 8 patients had a shorter AT cycle length (median of 273 versus 315 ms; P=0.003) and had a shorter resetting zone (median coupling interval of 30 versus 50 ms; P=0.01). Conclusions-APB delivered during AT in patients with a DAP advanced and/or delayed ventricular activation in all patients. In 1 of 5 of cases the AT was terminated by a single APB. In approximately a quarter of the patients an earlier coupled APB was needed to reset AT. The high RA was an adequate stimulation site in all right-sided DAP.
AB - Background-Advancement of ventricular activation by an atrial premature beat (APB) given during His bundle refractoriness followed by resetting of an antidromic tachycardia (AT) in patients with decrementally conducting accessory pathway (DAP) is a helpful maneuver to prove pathway existence and participation in the circuit. We aim to assess in a large cohort the role of APB during AT in patients with a DAP. Methods and Results-Thirty-three patients with a DAP having 34 AT were included in the study: 29 patients had an atriofascicular pathway, 1 had a long atrioventricular DAP, and 4 had a short atrioventricular fiber. APBs were delivered initially from the lateral right atrium, scanning diastole with a 10-ms decrement until AT termination or refractoriness. We observed 4 patterns of response after APB during AT: advancement of activation (29 cases), delay (2), advancement followed by delay (3), and termination (7). Eight patients required an earlier APB to advance or delay ventricular activation. These 8 patients had a shorter AT cycle length (median of 273 versus 315 ms; P=0.003) and had a shorter resetting zone (median coupling interval of 30 versus 50 ms; P=0.01). Conclusions-APB delivered during AT in patients with a DAP advanced and/or delayed ventricular activation in all patients. In 1 of 5 of cases the AT was terminated by a single APB. In approximately a quarter of the patients an earlier coupled APB was needed to reset AT. The high RA was an adequate stimulation site in all right-sided DAP.
KW - atriofascicular pathway
KW - antidromic tachycardia
KW - arrhythmia (mechanisms)
KW - decremental conduction
U2 - 10.1161/CIRCEP.112.000103
DO - 10.1161/CIRCEP.112.000103
M3 - Article
C2 - 23457113
SN - 1941-3149
VL - 6
SP - 357
EP - 363
JO - Circulation-Arrhythmia and Electrophysiology
JF - Circulation-Arrhythmia and Electrophysiology
IS - 2
ER -