TY - JOUR
T1 - When and how does a single ventricular premature beat initiate and terminate supraventricular tachycardia?
AU - Guerra, Magno Cunha
AU - Lokhandwala, Yash
AU - Oyarzun, Rodulfo
AU - Vyas, Aniruddha
AU - Correa, Frederico Soares
AU - Cruz Filho, Fernando Eugenio
AU - Wellens, Hein J.
AU - Sternick, Eduardo Back
N1 - Funding Information:
We are indebted to Isabel Cristina Gomes, Stat, PhD, for helping us with the statistical analysis.
Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2019/9
Y1 - 2019/9
N2 - Background The differential diagnosis of a supraventricular tachycardia (SVT) is accomplished using a number of pacing maneuvers. The incidence and mechanism of a single ventricular premature beat (VPB) on initiation and termination of tachycardia were evaluated during programmed electrical stimulation (PES) of the heart in patients with the two most common regular SVTs: atrioventricular re-entrant tachycardia (AVNRT) and orthodromic atrioventricular tachycardia (AVRT). Methods Three hundred and thirty-seven consecutive patients aged above 18 years with an inducible sustained AVNRT or AVRT were prospectively enrolled. Patients with more than one tachyarrhythmia mechanism were excluded. Two hundred and seventeen patients (64.4%) had typical slow/fast AVNRT and 120 (35.6%) had an orthodromic AVRT using a rapidly conducting accessory pathway for V-A conduction. In this cross-sectional study, we specifically report the analysis of tachycardia induction and termination by a single VPB. Results Tachycardia induction with a single VPB during sinus rhythm was seen in 7 of 120 AVRT and in only one of the 217 patients with AVNRT, (5.8% vs. 0.3%, p <0.05). When a single VPB was delivered during basic ventricular pacing these values were 28% versus 4%, respectively, (p <0.001). Termination of tachycardia by a single VPB was observed in nine (4.1%) patients with AVNRT and in 57 (47.5%) with AVRT (p <0.001). Conclusion Initiation of SVT by a single VPB during sinus rhythm was uncommon and favored AVRT. Termination of SVT by a single VPB was commonly seen in AVRT but rarely in AVNRT. These findings can be of help when interpreting a noninvasive arrhythmia event recording.
AB - Background The differential diagnosis of a supraventricular tachycardia (SVT) is accomplished using a number of pacing maneuvers. The incidence and mechanism of a single ventricular premature beat (VPB) on initiation and termination of tachycardia were evaluated during programmed electrical stimulation (PES) of the heart in patients with the two most common regular SVTs: atrioventricular re-entrant tachycardia (AVNRT) and orthodromic atrioventricular tachycardia (AVRT). Methods Three hundred and thirty-seven consecutive patients aged above 18 years with an inducible sustained AVNRT or AVRT were prospectively enrolled. Patients with more than one tachyarrhythmia mechanism were excluded. Two hundred and seventeen patients (64.4%) had typical slow/fast AVNRT and 120 (35.6%) had an orthodromic AVRT using a rapidly conducting accessory pathway for V-A conduction. In this cross-sectional study, we specifically report the analysis of tachycardia induction and termination by a single VPB. Results Tachycardia induction with a single VPB during sinus rhythm was seen in 7 of 120 AVRT and in only one of the 217 patients with AVNRT, (5.8% vs. 0.3%, p <0.05). When a single VPB was delivered during basic ventricular pacing these values were 28% versus 4%, respectively, (p <0.001). Termination of tachycardia by a single VPB was observed in nine (4.1%) patients with AVNRT and in 57 (47.5%) with AVRT (p <0.001). Conclusion Initiation of SVT by a single VPB during sinus rhythm was uncommon and favored AVRT. Termination of SVT by a single VPB was commonly seen in AVRT but rarely in AVNRT. These findings can be of help when interpreting a noninvasive arrhythmia event recording.
KW - cardiac rhythm event recorders
KW - electrophysiologic study
KW - supraventricular tachycardia
KW - tachycardia mechanisms
KW - NODE REENTRANT TACHYCARDIA
KW - SEPTAL ACCESSORY PATHWAYS
KW - ATRIAL TACHYCARDIA
KW - ENTRAINMENT
KW - DIAGNOSIS
U2 - 10.1111/anec.12650
DO - 10.1111/anec.12650
M3 - Article
C2 - 30993813
SN - 1082-720X
VL - 24
JO - Annals of Noninvasive Electrocardiology
JF - Annals of Noninvasive Electrocardiology
IS - 5
M1 - 12650
ER -