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Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V‐A‐A‐V response
Introduction 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...
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| Published in: | Pacing and clinical electrophysiology 2022-07, Vol.45 (7), p.839-852 |
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| container_title | Pacing and clinical electrophysiology |
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| creator | Kaneko, Yoshiaki Nakajima, Tadashi Tamura, Shuntaro Nagashima, Koichi Kobari, Takashi Hasegawa, Hiroshi Ishii, Hideki |
| description | Introduction
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.
Methods
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.
Results
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 26 ms predicted a diagnosis of F/S‐AVNRT with a 76% sensitivity and 100% specificity, while a ΔAA |
| doi_str_mv | 10.1111/pace.14540 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2673594499</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2673594499</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4230-a84c98da79cbca0c0edd91f49cc87bd5e97f12ff5ad041e2216e479e6f3d25ae3</originalsourceid><addsrcrecordid>eNp9kc1KxDAUhYMoOv5sfAApuBGhmrRp0yyH8RcEXajbcie5wUqnqUmrdCH4CD6jT2LGGUVcGAgnHL4cbnII2WX0iIV13ILCI8YzTlfIiAWJC5bJVTKijIu4SAu5QTa9f6SU5pRn62QjzfKcsYKPyOtJ5ZWrZlUDXWWbyJoIuqGtFNTh4Cr7jE0Q1dfgosbqYDucW9B0UQfqYVDgdAWRcXb2dSMQv_3pEHUPGN1_vL2Pl_s-RPjWNh63yZqB2uPOUrfI3dnp7eQivro-v5yMr2LFk5TGUHAlCw1CqqkCqihqLZnhUqlCTHWGUhiWGJOBppxhkrAcuZCYm1QnGWC6RQ4Wua2zTz36rpyFZ2NdQ4O292WSizSTnEsZ0P0_6KPtXROmC1QhRMqo4IE6XFDKWe8dmrINnwhuKBkt56WU81LKr1ICvLeM7Kcz1D_odwsBYAvgpapx-CeqvBlPThehn1vQnCw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2687731074</pqid></control><display><type>article</type><title>Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V‐A‐A‐V response</title><source>Wiley-Blackwell Read & Publish Collection</source><source>SPORTDiscus</source><creator>Kaneko, Yoshiaki ; Nakajima, Tadashi ; Tamura, Shuntaro ; Nagashima, Koichi ; Kobari, Takashi ; Hasegawa, Hiroshi ; Ishii, Hideki</creator><creatorcontrib>Kaneko, Yoshiaki ; Nakajima, Tadashi ; Tamura, Shuntaro ; Nagashima, Koichi ; Kobari, Takashi ; Hasegawa, Hiroshi ; Ishii, Hideki</creatorcontrib><description>Introduction
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.
Methods
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.
Results
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.
Conclusions
ΔAA is a useful, confirmatory, diagnostic indicator of F/S‐AVNRT versus AT associated with the V‐A‐A‐V response.</description><identifier>ISSN: 0147-8389</identifier><identifier>EISSN: 1540-8159</identifier><identifier>DOI: 10.1111/pace.14540</identifier><identifier>PMID: 35661184</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>atrial tachycardia ; atrioventricular nodal reentrant tachycardia ; Cardiac arrhythmia ; cardiac electrophysiology ; Diagnosis ; dual atrioventricular nodal conduction ; Entrainment ; Septum ; Tachycardia ; Ventricle</subject><ispartof>Pacing and clinical electrophysiology, 2022-07, Vol.45 (7), p.839-852</ispartof><rights>2022 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4230-a84c98da79cbca0c0edd91f49cc87bd5e97f12ff5ad041e2216e479e6f3d25ae3</citedby><cites>FETCH-LOGICAL-c4230-a84c98da79cbca0c0edd91f49cc87bd5e97f12ff5ad041e2216e479e6f3d25ae3</cites><orcidid>0000-0003-2326-225X ; 0000-0001-9611-2303 ; 0000-0002-9635-2769 ; 0000-0003-4348-0123</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35661184$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kaneko, Yoshiaki</creatorcontrib><creatorcontrib>Nakajima, Tadashi</creatorcontrib><creatorcontrib>Tamura, Shuntaro</creatorcontrib><creatorcontrib>Nagashima, Koichi</creatorcontrib><creatorcontrib>Kobari, Takashi</creatorcontrib><creatorcontrib>Hasegawa, Hiroshi</creatorcontrib><creatorcontrib>Ishii, Hideki</creatorcontrib><title>Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V‐A‐A‐V response</title><title>Pacing and clinical electrophysiology</title><addtitle>Pacing Clin Electrophysiol</addtitle><description>Introduction
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.
Methods
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.
Results
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.
Conclusions
ΔAA is a useful, confirmatory, diagnostic indicator of F/S‐AVNRT versus AT associated with the V‐A‐A‐V response.</description><subject>atrial tachycardia</subject><subject>atrioventricular nodal reentrant tachycardia</subject><subject>Cardiac arrhythmia</subject><subject>cardiac electrophysiology</subject><subject>Diagnosis</subject><subject>dual atrioventricular nodal conduction</subject><subject>Entrainment</subject><subject>Septum</subject><subject>Tachycardia</subject><subject>Ventricle</subject><issn>0147-8389</issn><issn>1540-8159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kc1KxDAUhYMoOv5sfAApuBGhmrRp0yyH8RcEXajbcie5wUqnqUmrdCH4CD6jT2LGGUVcGAgnHL4cbnII2WX0iIV13ILCI8YzTlfIiAWJC5bJVTKijIu4SAu5QTa9f6SU5pRn62QjzfKcsYKPyOtJ5ZWrZlUDXWWbyJoIuqGtFNTh4Cr7jE0Q1dfgosbqYDucW9B0UQfqYVDgdAWRcXb2dSMQv_3pEHUPGN1_vL2Pl_s-RPjWNh63yZqB2uPOUrfI3dnp7eQivro-v5yMr2LFk5TGUHAlCw1CqqkCqihqLZnhUqlCTHWGUhiWGJOBppxhkrAcuZCYm1QnGWC6RQ4Wua2zTz36rpyFZ2NdQ4O292WSizSTnEsZ0P0_6KPtXROmC1QhRMqo4IE6XFDKWe8dmrINnwhuKBkt56WU81LKr1ICvLeM7Kcz1D_odwsBYAvgpapx-CeqvBlPThehn1vQnCw</recordid><startdate>202207</startdate><enddate>202207</enddate><creator>Kaneko, Yoshiaki</creator><creator>Nakajima, Tadashi</creator><creator>Tamura, Shuntaro</creator><creator>Nagashima, Koichi</creator><creator>Kobari, Takashi</creator><creator>Hasegawa, Hiroshi</creator><creator>Ishii, Hideki</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2326-225X</orcidid><orcidid>https://orcid.org/0000-0001-9611-2303</orcidid><orcidid>https://orcid.org/0000-0002-9635-2769</orcidid><orcidid>https://orcid.org/0000-0003-4348-0123</orcidid></search><sort><creationdate>202207</creationdate><title>Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V‐A‐A‐V response</title><author>Kaneko, Yoshiaki ; Nakajima, Tadashi ; Tamura, Shuntaro ; Nagashima, Koichi ; Kobari, Takashi ; Hasegawa, Hiroshi ; Ishii, Hideki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4230-a84c98da79cbca0c0edd91f49cc87bd5e97f12ff5ad041e2216e479e6f3d25ae3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>atrial tachycardia</topic><topic>atrioventricular nodal reentrant tachycardia</topic><topic>Cardiac arrhythmia</topic><topic>cardiac electrophysiology</topic><topic>Diagnosis</topic><topic>dual atrioventricular nodal conduction</topic><topic>Entrainment</topic><topic>Septum</topic><topic>Tachycardia</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kaneko, Yoshiaki</creatorcontrib><creatorcontrib>Nakajima, Tadashi</creatorcontrib><creatorcontrib>Tamura, Shuntaro</creatorcontrib><creatorcontrib>Nagashima, Koichi</creatorcontrib><creatorcontrib>Kobari, Takashi</creatorcontrib><creatorcontrib>Hasegawa, Hiroshi</creatorcontrib><creatorcontrib>Ishii, Hideki</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pacing and clinical electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kaneko, Yoshiaki</au><au>Nakajima, Tadashi</au><au>Tamura, Shuntaro</au><au>Nagashima, Koichi</au><au>Kobari, Takashi</au><au>Hasegawa, Hiroshi</au><au>Ishii, Hideki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V‐A‐A‐V response</atitle><jtitle>Pacing and clinical electrophysiology</jtitle><addtitle>Pacing Clin Electrophysiol</addtitle><date>2022-07</date><risdate>2022</risdate><volume>45</volume><issue>7</issue><spage>839</spage><epage>852</epage><pages>839-852</pages><issn>0147-8389</issn><eissn>1540-8159</eissn><abstract>Introduction
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.
Methods
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.
Results
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.
Conclusions
ΔAA is a useful, confirmatory, diagnostic indicator of F/S‐AVNRT versus AT associated with the V‐A‐A‐V response.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>35661184</pmid><doi>10.1111/pace.14540</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0003-2326-225X</orcidid><orcidid>https://orcid.org/0000-0001-9611-2303</orcidid><orcidid>https://orcid.org/0000-0002-9635-2769</orcidid><orcidid>https://orcid.org/0000-0003-4348-0123</orcidid></addata></record> |
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| ispartof | Pacing and clinical electrophysiology, 2022-07, Vol.45 (7), p.839-852 |
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| subjects | atrial tachycardia atrioventricular nodal reentrant tachycardia Cardiac arrhythmia cardiac electrophysiology Diagnosis dual atrioventricular nodal conduction Entrainment Septum Tachycardia Ventricle |
| title | Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V‐A‐A‐V response |
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