Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V-A-A-V response.
atrial tachycardia
atrioventricular nodal reentrant tachycardia
cardiac electrophysiology
dual atrioventricular nodal conduction
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
revised:
25
04
2022
received:
13
01
2022
accepted:
22
05
2022
pubmed:
7
6
2022
medline:
14
7
2022
entrez:
6
6
2022
Statut:
ppublish
Résumé
The electrophysiological discrimination between fast-slow (F/S-) atrioventricular (AV) nodal reentrant tachycardia (NRT) and atrial tachycardia (AT) originating from the interatrial septum remains challenging. While a V-A-A-V response may occur immediately after ventricular induction or entrainment of either tachycardia, the electrophysiological dissimilarities in that response between the two tachycardias remain unclear. The purpose of this study was to identify a diagnostic indicator discriminating F/S-AVNRT from AT by examining the difference in the V-A-A-V response between the two tachycardias. This retrospective study included 17 patients with F/S-AVNRT [seven with common-form F/S-AVNRT using a typical slow pathway (SP) and 10 with superior type F/S-AVNRT using a superior SP] and 10 patients with reentrant AT. All 27 patients presented with long RP supraventricular tachycardia and an initial V-A-A-V response upon ventricular induction or entrainment. The V-A-A-V response in patients with F/S-AVNRT was due to dual atrial responses. We measured the interval between the first (A1) and second atrial electrogram (A2) of V-A-A-V and calculated ΔAA by subtracting A1-A2 from the tachycardia cycle length. V-A-A-V responses were observed most often upon ventricular induction of F/S-AVNRT (6 ± 5 times) as well as AT (6 ± 6 times; p = .87). The V-A-A-V response upon ventricular entrainment was observed in a single patient with F/S-AVNRT versus 10 all patients with AT (p < .001). ΔAA ranged between -80 and 228 ms in F/S-AVNRT and between -184 and 26 ms in AT. A ΔAA > 26 ms predicted a diagnosis of F/S-AVNRT with a 76% sensitivity and 100% specificity, while a ΔAA <-80 ms predicted a diagnosis of AT with a 50% sensitivity and 100% specificity. ΔAA is a useful, confirmatory, diagnostic indicator of F/S-AVNRT versus AT associated with the V-A-A-V response.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
839-852Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: executive Summary: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2016;67:1575-1623.
Katritsis DG, Boriani G, Cosio FG, et al. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace. 2017;19:465-511.
Kaneko Y, Naito S, Okishige K, et al. Atypical fast-slow atrioventricular nodal reentrant tachycardia incorporating a “superior” slow pathway: a distinct supraventricular tachyarrhythmia. Circulation. 2016;133: 14-123.
Kaneko Y, Nakajima T, Irie T, Iizuka T, Tamura S, Kurabayashi M. Atrial and ventricular activation sequence after ventricular induction/entrainment pacing during fast-slow atrioventricular nodal reentrant tachycardia: new insight into the use of V-A-A-V for the differential diagnosis of supraventricular tachycardia. Heart Rhythm. 2017;14:1615-1622.
Kaneko Y, Nakajima T, Tamura S, et al. Superior-type fast-slow atrioventricular nodal reentrant tachycardia phenotype mimicking the slow-fast type. Circ Arrhythm Electrophysio. 2020;13:e008732.
Doi A, Takagi M, Yoshiyama M. Conversion of wide QRS tachycardia with a long RP interval in pre-excitation syndrome: what is the mechanism? J Cardiovasc Electrophysiol. 2018;29:1450-1453.
Itoh T, Kimura M, Ishida Y, Tomita H. Cycle length alternans during an atypical atrioventricular nodal re-entrant tachycardia utilizing a superior slow pathway. Europace. 2018;20:1114.
Wakabayashi Y, Mitsuhashi T, Yamamoto S, Fujita H, Momomura SI. Unusual atrial activation recorded near the His bundle during supraventricular tachycardia: what is the mechanism? Pacing Clin Electrophysiol. 2019;42:289-292.
Chen Q, Liu Q, Jiang C. Supraventricular tachycardia with atrial activation earliest at the His bundle region-What is the mechanism? J Cardiovasc Electrophysiol. 2019;30:2535-2538.
Iesaka Y, Takahashi A, Goya M, et al. Adenosine-sensitive atrial reentrant tachycardia originating from the atrioventricular nodal transitional area. J Cardiovasc Electrophysiol. 1997;8:854-864.
Horie T, Miyauchi Y, Kobayashi Y, et al. Adenosine-sensitive atrial tachycardia originating from the proximal coronary sinus. Heart Rhythm. 2005;2:1301-1308.
Saoudi N, Cosío F, Waldo A, et al, Working Group of Arrhythmias of the European of Cardiology and the North American Society of Pacing and Electrophysiology. A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases; a Statement from a Joint Expert Group from The Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 2001;22:1162-1182.
Knight BP, Zivin A, Souza J, et al. A technique for the rapid diagnosis of atrial tachycardia in the electrophysiology laboratory. J Am Coll Cardiol. 1999;33:775-781.
Kaneko Y, Nakajima T, Irie T, Ota M, Iijima T, Kurabayashi M. V-A-A-V activation sequence at the onset of a long RP tachycardia: what is the mechanism? J Cardiovasc Electrophysiol. 2015;26:101-103.
Yamabe H, Okumura K, Tabuchi T, Tsuchiya T, Yasue H. Double atrial responses to a single ventricular impulse in long RP' tachycardia. Pacing Clin Electrophysiol. 1996;19:403-410.
Lin FC, Yeh SJ, Wu D. Double atrial responses to a single ventricular impulse due to simultaneous conduction via two retrograde pathways. J Am Coll Cardio. 1985;5:168-175.
Kaneko Y, Nakajima T, Tamura S, Hasegawa H, Kobari T, Ishii H. Pacing site- and rate-dependent shortening of retrograde conduction time over the slow pathway after atrial entrainment of fast-slow atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol. 2021;32:2979-2986.
Vijayaraman P, Lee BP, Kalahasty G, Wood MA, Ellenbogen KA. Reanalysis of the “pseudo A-A-V” response to ventricular entrainment of supraventricular tachycardia: importance of his-bundle timing. J Cardiovasc Electrophysiol. 2006;17:25-28.
Kaneko Y, Nakajima T, Tamura S, Hasegawa H, Kobari T, Kurabayashi M. V-A-A-V activation sequence followed by an induction of long RP tachycardia: what is the mechanism? J Cardiovasc Electrophysiol. 2021;32:540-544.
AlMahameed ST, Buxton AE, Michaud GF. New criteria during right ventricular pacing to determine the mechanism of supraventricular tachycardia. Circ Arrhythm Electrophysiol. 2010;3:578-584.
Maruyama M, Kobayashi Y, Miyauchi Y, et al. The VA relationship after differential atrial overdrive pacing: a novel tool for the diagnosis of atrial tachycardia in the electrophysiologic laboratory. J Cardiovasc Electrophysiol. 2007;18:1127-1133.
Kaneko Y, Nakajima T, Iizuka T, Tamura S, Kurabayashi M. A case of atypical fast-slow atrioventricular nodal reentrant tachycardia utilizing a slow pathway extending to the superoanterior right atrium. Int Heart J. 2019;60:756-760.
Kaneko Y, Nakajima T, Nogami A, et al. Atypical fast-slow atrioventricular nodal reentrant tachycardia utilizing a slow pathway extending to the inferolateral right atrium. Circ Rep. 2019;1:46-54.
Kaneko Y, Nakajima T, Tamura S, Hasegawa H, Kurabayashi M. A V-A-V response during induction of supraventricular tachycardia: what is the mechanism? J Arrhythm. 2019;35:692-695.
Chien WW, Cohen TJ, Lee MA, et al. Electrophysiological findings and long-term follow-up of patients with the permanent form of junctional reciprocating tachycardia treated by catheter ablation. Circulation. 1992;85:1329-1336.
Man KC, Niebauer M, Daoud E, et al. Comparison of atrial-His intervals during tachycardia and atrial pacing in patients with long RP tachycardia. J Cardiovasc Electrophysiol. 1995;6:700-710.
Yamabe H, Shimasaki Y, Honda O, Kimura Y, Hokamura Y. Demonstration of the exact anatomic tachycardia circuit in the fast-slow form of atrioventricular nodal reentrant tachycardia. Circulation. 2001;104:1268-1273.
Kaneko Y, Nakajima T, Irie T, et al. Differential diagnosis of supraventricular tachycardia with ventriculoatrial dissociation during ventricular overdrive pacing. Pacing Clin Electrophysiol. 2011;34:1028-1030.
Wood M, Kiser R, Ellenbogen K. Atrioventricular nodal reentry with retrograde lower common pathway block: a case report. J Cardiovasc Electrophysiol. 2011;22:934-937.
Kinjo T, Sasaki S, Kimura M, et al. Long postpacing interval after entrainment of tachycardia including a slow conduction zone within the circuit. J Cardiovasc Electrophysiol. 2016;27:923-929.
Kahle AK, Gallotti RG, Alken FA, Meyer C, Moore JP. Electrophysiological characteristics of intra-atrial reentrant tachycardia in adult congenital heart disease: implications for catheter ablation. J Am Heart Assoc. 2021;10:e020835.
Lai LP, Lin JL, Chen TF, Ko WC, Lien WP. Clinical, electrophysiological characteristics, and radiofrequency catheter ablation of atrial tachycardia near the apex of Koch's triangle. Pacing Clin Electrophysiol. 1998;21:367-374.
Frey B, Kreiner G, Gwechenberger M, Gössinger HD. Ablation of atrial tachycardia originating from the vicinity of the atrioventricular node: significance of mapping both sides of the interatrial septum. J Am Coll Cardiol. 2001;38:394-400.
Ouyang F, Ma J, Ho SY, et al. Focal atrial tachycardia originating from the non-coronary aortic sinus: electrophysiological characteristics and catheter ablation. J Am Coll Cardiol. 2006;48:122-131.
Koyama J, Yamabe H, Tanaka Y, et al. Spatial and topologic distribution of verapamil-sensitive atrial tachycardia originating from the vicinity of the atrioventricular node. Pacing Clin Electrophysiol. 2007;30:1511-1121.
Das S, Neuzil P, Albert CM, et al. Catheter ablation of peri-AV nodal atrial tachycardia from the noncoronary cusp of the aortic valve. J Cardiovasc Electrophysiol. 2008;19:231-237.
Hiramatsu S, Tada H, Sakamoto Y, et al. Quantitative analysis and characteristics of the electrograms recorded within the non-coronary aortic sinus of Valsalva. Circ J. 2009;73:838-845.
Yamabe H, Tanaka Y, Morihisa K, et al. Analysis of the anatomical tachycardia circuit in verapamil-sensitive atrial tachycardia originating from the vicinity of the atrioventricular node. Circ Arrhythm Electrophysiol. 2010;3:54-62.
Zhou YF, Wang Y, Zeng YJ, et al. Electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia arising from non-coronary sinuses of Valsalva in the aorta. J Interv Card Electrophysiol. 2010;28:147-151.
Iwai S, Badhwar N, Markowitz SM, et al. Electrophysiologic properties of para-Hisian atrial tachycardia. Heart Rhythm. 2011;8:1245-1253.
Ju W, Chen M, Yang B, et al. The role of noncoronary cusp ablation approach in the treatment of perinodal atrial tachycardias. Pacing Clin Electrophysiol. 2012;35:811-818.
Yamabe H, Okumura K, Morihisa K, et al. Demonstration of anatomical reentrant tachycardia circuit in verapamil-sensitive atrial tachycardia originating from the vicinity of the atrioventricular node. Heart Rhythm. 2012;9:1475-1483.
Nakamura T, Hachiya H, Tanaka Y, et al. Distribution of the origin of adenosine triphosphate-sensitive atrial tachycardias with the earliest activation recorded in the His bundle catheter: are they limited to the immediate vicinity of the His bundle? Circ J. 2013;77:626-631.
Mano H, Okumura Y, Watanabe I, et al. Potential anatomic substrate of peri-atrioventricular nodal atrial tachycardia ablated from the noncoronary sinus of Valsalva. J Interv Card Electrophysiol. 2013;38:27-34.
Wang Z, Ouyang J, Liang Y, et al. Focal atrial tachycardia surrounding the anterior septum: strategy for mapping and catheter ablation. Circ Arrhythm Electrophysiol. 2015;8:575-582.
Pap R, Makai A, Szilágyi J, et al. Should the aortic root be the preferred route for ablation of focal atrial tachycardia around the AV node? Support from intracardiac echocardiography. JACC Clin Electrophysiol. 2016;2:193-199.
Okumura K, Sasaki S, Kimura M, et al. Usefulness of combined CARTO electroanatomical mapping and manifest entrainment in ablating adenosine triphosphate-sensitive atrial tachycardia originating from the atrioventricular node vicinity. J Arrhythm. 2016;32:133-140.
Lyan E, Toniolo M, Tsyganov A, et al. Comparison of strategies for catheter ablation of focal atrial tachycardia originating near the His bundle region. Heart Rhythm. 2017;14:998-1005.
Yang JD, Sun Q, Guo XG, et al. Focal atrial tachycardias from the parahisian region: strategies for mapping and catheter ablation. Heart Rhythm. 2017;14:1344-1350.
Okishige K, Shigeta T, Nishimura T, et al. Cryofreezing catheter ablation of adenosine triphosphate sensitive atrial tachycardia. J Cardiovasc Electrophysiol. 2019;30:528-537.
Yamabe H, Kajiyama K, Soejima T, et al. Comparison of the catheter ablation outcome in patients between targeting the entrance and exit of the reentry circuit in verapamil-sensitive atrial tachycardia originating from the atrioventricular-node vicinity. Heart Vessels. 2021;36:1201-1211.
Kaneko Y, Nakajima T, Tamura S, Kurabayashi M. Superior-type fast-slow atrioventricular nodal reentrant tachycardia with a 2:1 atrioventricular block. J Cardiovasc Electrophysiol. 2019;30:1696-1698.
Crawford TC, Mukerji S, Good E, et al. Utility of atrial and ventricular cycle length variability in determining the mechanism of paroxysmal supraventricular tachycardia. J Cardiovasc Electrophysiol. 2007;18:698-703.