title: [Usefulness of incremental atrial pacing for evaluating the effectiveness of the ablation of the slow perinodal pathway].
abstract: OBJECTIVE
  To study the usefulness of incremental atrial pacing for evaluating the effect of radiofrequency catheter ablation on slow pathway conduction in patients with atrioventricular (AV) nodal reentrant tachycardia.
  
  
  METHODS
  A prospective study was carried out in patients either with (i.e., AV nodal reentrant tachycardia group) or without (i.e., control group) inducible AV nodal reentrant tachycardia who were referred for electrophysiologic study. Incremental atrial pacing involved gradually decreasing the pacing cycle length until the PR interval exceeded the R-R interval (i.e., PR>RR) or AV nodal block occurred. The presence of dual anterograde AV nodal physiology was assessed during programmed atrial stimulation using standard criteria. In the AV nodal reentrant tachycardia group, electrophysiologic study was repeated 30 minutes after successful catheter ablation.
  
  
  RESULTS
  In the AV nodal reentrant tachycardia group (n=85), 52 patients (61%) exhibited dual AV nodal physiology during programmed atrial stimulation and 66 (78%) had a PR>RR during incremental atrial pacing. In the control group, the corresponding proportions were 10/56 (18%) and 7/56 (12%), respectively. After successful slow pathway catheter ablation (81/85), 37/81 exhibited dual AV nodal physiology during programmed atrial stimulation while 1/81 had a PR>RR during incremental atrial pacing. The positive predictive value of successful slow pathway ablation for the absence of a PR>RR was 98%.
  
  
  CONCLUSIONS
  Incremental atrial pacing demonstrated that the PR interval exceeded the R-R interval in the majority of patients with inducible AV nodal reentrant tachycardia. This technique could provide a fast and simple way of evaluating the effect of radiofrequency catheter ablation on slow pathway conduction.
authors.affiliation: Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. juanmsmur@secardiologia.es
authors.forename: Juan
authors.initials: J
authors.lastname: Martínez-Sánchez
authors.forename: Arcadi
authors.initials: A
authors.lastname: García-Alberola
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Sánchez-Muñoz
authors.forename: Carmen
authors.initials: C
authors.lastname: Cerdán-Sánchez
authors.forename: Belén
authors.initials: B
authors.lastname: Redondo-Bermejo
authors.forename: Juan A
authors.initials: JA
authors.lastname: Ruipérez-Abizanda
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés-Chávarri
mesh_terms: D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology / Q000601:surgery*