Overdrive atrial stimulation during transesophageal electrophysiological study: usefulness of post-pacing VA interval analysis in differentiating supraventricular tachycardias with 1:1 atrio-ventricular relationship

• Published in: International journal of cardiology 1997-10, Vol.62 (1), p.37-45
• Main Authors: Tritto, Massimo, Dicandia, Cosimo Damiano, Calabrese, Pietro
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analysis of Variance; Atrial tachycardia; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Pacing, Artificial - methods; Cardiology. Vascular system; Diagnosis, Differential; Electrocardiography; Electrophysiological study; Esophagus; Feasibility Studies; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Reference Values; Sensitivity and Specificity; Tachycardia, Atrioventricular Nodal Reentry - diagnosis; Tachycardia, Atrioventricular Nodal Reentry - physiopathology; Tachycardia, Ectopic Atrial - diagnosis; Tachycardia, Ectopic Atrial - physiopathology; Tachycardia, Supraventricular - classification; Tachycardia, Supraventricular - physiopathology; Transesophageal pacing
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/S0167-5273(97)00190-3

We evaluated the feasibility and usefulness of overdrive atrial pacing to identify the relationship between atrial and ventricular activation in supraventricular tachycardias with a stable 1:1 atrio-ventricular (AV) conduction ratio during a transesophageal electrophysiological investigation. Overdrive atrial stimulation was performed in 42 consecutive patients (11 males and 31 females; mean age 49±17 years) during AV junctional reentrant tachycardia, orthodromic AV reentrant tachycardia and ectopic atrial tachycardia (22, 13 and seven subjects, respectively). Trains of 12 stimuli at a constant rate were introduced starting at a cycle length 10 ms shorter than the tachycardia cycle length; stimulation was repeated with a 10-ms decrement in pacing cycle length at each step until tachycardia terminated and/or second-degree AV block occurred. The difference between the VA interval duration at baseline and in the first post-pacing tachycardia beat was measured at each step and provided identification of the AV relationship. At least one post-pacing VA interval was evaluable in 90% of the cases and measured 2±4 and 1±3 ms in AV junctional and AV reentrant tachycardia groups, respectively, and 83±42 ms in the ectopic atrial tachycardia group ( P