Entrainment from the para-Hisian region for differentiating atrioventricular node reentrant tachycardia from orthodromic atrioventricular reentrant tachycardia.
OBJECTIVE
The difference between the stimulus-atrial and ventriculo-atrial intervals (SA-VA) and between the post-pacing interval and the tachycardia cycle length (PPI-TCL) during entrainment from the right ventricular apex distinguishes atrioventricular node reentrant (AVNRT) from orthodromic atrioventricular reentrant tachycardia (AVRT). We hypothesized that these features still apply when entrainment is performed from the para-Hisian region.


RESULTS
Forty-seven supraventricular tachycardias (34 AVNRT/13 AVRT) were included. The SA-VA and PPI-TCL were obtained in all patients by using two right-sided diagnostic catheters. In 24 of them, these measurements were also performed upon His-bundle capture during entrainment. A paced QRS widening of >or=40 ms during entrainment, when compared with the tachycardia QRS width, identified absence of His-bundle capture, P < 0.001. A SA-VA >75 ms distinguished AVNRT from AVRT, P < 0.001 (sensitivity/specificity 97%/100%). A PPI-TCL >100 ms was diagnostic of AVNRT, P < 0.001 (sensitivity/specificity 97%/92%). Upon His-bundle capture, the SA-VA and PPI-TCL shortened in AVNRT (121 +/- 23 to 66 +/- 24 ms; 139 +/- 30 to 85 +/- 31 ms, respectively, P < 0.001) and no longer differentiated AVNRT from AVRT.


CONCLUSIONS
Para-Hisian entrainment without His-bundle capture distinguishes AVNRT from AVRT with the advantage of using only two diagnostic catheters.
Pérez-Rodon
Jordi
J
Electrophysiology Unit, Cardiology Department, Hospital del Mar, IMAS, 25 Passeig Marítim, 08003 Barcelona, Spain.
Bazan
Victor
V
Bruguera-Cortada
Jordi
J
Mojal-García
Sergi
S
Manresa-Domínguez
Josep M
JM
Martí-Almor
Julio
J
D018780:Body Surface Potential Mapping / Q000379:methods*; D002036:Bundle of His; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000145:classification / Q000175:diagnosis* / Q000628:therapy*