Limitations of ventricular pacing maneuvers to differentiate orthodromic reciprocating tachycardia from atrioventricular nodal reentry tachycardia

Purpose Various ventricular pacing maneuvers have been developed to differentiate orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentry tachycardia (AVNRT). We aimed to evaluate the diagnostic value of ventricular pacing maneuvers in patients undergoing catheter ablation fo...

Teljes leírás

Elmentve itt :
Bibliográfiai részletek
Szerzők: Kupó Péter
Tutuianu Cristina Ioana
Kaninski Genadi
Gingl Zoltán
Sághy László
Pap Róbert
Dokumentumtípus: Cikk
Megjelent: 2021
Sorozat:JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY
Tárgyszavak:
doi:10.1007/s10840-021-00993-1

mtmt:32367264
Online Access:http://publicatio.bibl.u-szeged.hu/23285
Leíró adatok
Tartalmi kivonat:Purpose Various ventricular pacing maneuvers have been developed to differentiate orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentry tachycardia (AVNRT). We aimed to evaluate the diagnostic value of ventricular pacing maneuvers in patients undergoing catheter ablation for AVNRT/ORT. Methods Sixty patients with supraventricular tachycardia (SVT) undergoing invasive EP study were included (ORT: 31, typical AVNRT: 18, atypical AVNRT: 11). Ventricular overdrive pacing (VOP) and resetting by premature ventricular stimulation (PVS) during SVT were analyzed by 3 independent observers blinded to the ultimate diagnosis. We determined intraclass correlation coefficient (ICC) for interobserver agreement and the diagnostic accuracy of consensual results. Results Although specificity of all parameters was high (96-100%) for ORT, semi-quantitative parameters of VOP (requiring the recognition of specific ECG patterns) had lower interobserver reliability (ICC: 0.32-0.66) and sensitivity (16.1-77.4%). In contrast, most quantitative measurements of VOP and PVS showed good reproducibility (ICC: 0.93-0.95) and sensitivity (74.2-89.3%), but post-pacing interval after VOP needed correction with AV nodal conduction slowing. False negative results for diagnosing ORT were more common with left free wall vs. right free wall or septal, and slowly vs. fast-conducting septal APs. False positivity was only seen with a bystander, concealed nodo-fascicular/nodo-ventricular (NF/NV) AP in a case of AVNRT. Conclusions No single maneuver is 100% sensitive for ORT. Semi-quantitative features have limited reproducibility and all parameters can be misleading in the case of rate-dependent delay during VOP/PVS, ORT circuits remote from the pacing site, or a bystander, concealed NF/NV AP.
ISSN:1383-875X