[Predictive value of induction of atrial flutter or fibrillation in paroxysmal junctional tachycardia].
The association of different types of tachycardia in a given patient is a well-known phenomenon and the development of ablative methods rises hopes that treatment of one of them may suppress the others. The aim of this study was to determine the significance of induction of atrial flutter or fibrillation (AF) during electrophysiological investigation of patients investigated for paroxysmal junctional tachycardia. The initial population of 500 patients was limited to 485 patients, aged 12 to 86, with a normal intercritical ECG and without a Wolff-Parkinson-White syndrome, who underwent electrophysiological investigation for junctional tachycardias since 1978 and in whom the tachycardia could be reproduced. The study was performed by the endocavitary approach in 262 cases and by the transoesophageal approach in 213 cases with a similar protocol, programmed atrial stimulation with 1 and 2 extrastimuli under basal conditions, eventually completed by the repetition of the protocol with low doses of isoproterenol. The electrophysiological study showed that the tachycardia involved a latent bundle of Kent in 103 cases, a double nodal pathway in 343 cases or another circuit in 39 cases. During this study, sustained AF was induced in 66 cases (13.5%) with a similar incidence in Kent bundles (14.5%), intranodal reentry (11%) and other forms of reentry (11%). During follow-up, ranging from 6 months to 10 years, 7 patients with induced AF and 9 without inducible tachycardia, developed permanent AF. The occurrence of the arrhythmia was significantly correlated with the mechanism of reentry (latent Kent 8/103 cases, intranodal reentry 8/343 cases, p < 0.05), and with the induction of the same arrhythmia by oesophageal investigation alone (p < 0.001). The initiation of the arrhythmia by endocavitary stimulation did not seem to have any positive predictive value. In conclusion, the induction of atrial flutter or fibrillation during investigation of a subject with paroxysmal junctional tachycardia without a patent Wolff-Parkinson-White syndrome, does not seem to be predictive of future development of atrial flutter or fibrillation, unless the investigation was undertaken by the oesophageal approach.
Service de cardiologie, CHU Brabois, 54511 Vandoeuvres-lès-Nancy.
B
B
Brembilla-Perrot
P
P
Houriez
D
D
Beurrier
J P
JP
Preiss
A
A
Terrier de la Chaise
P
P
Louis
O
O
Claudon
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000139:chemically induced / Q000473:pathology*; D001282:Atrial Flutter / Q000139:chemically induced / Q000473:pathology*; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000494:pharmacology; D002648:Child; D004558:Electric Stimulation; D004562:Electrocardiography; D004947:Esophagus; D005260:Female; D006801:Humans; D007545:Isoproterenol / Q000008:administration & dosage / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013614:Tachycardia, Paroxysmal / Q000503:physiopathology*
D002316:Cardiotonic Agents; D007545:Isoproterenol