title: Differentiating junctional tachycardia and atrioventricular node re-entry tachycardia based on response to atrial extrastimulus pacing.
abstract: OBJECTIVE
  The purpose of this study was to differentiate non-re-entrant junctional tachycardia (JT) and typical atrioventricular node re-entry tachycardia (AVNRT).
  
  
  BACKGROUND
  JT may mimic AVNRT. Ablation of JT is associated with a lower success rate and a higher incidence of heart block. Electrophysiologic differentiation of these tachycardias is often difficult.
  
  
  METHODS
  We hypothesized that JT can be distinguished from AVNRT based on specific responses to premature atrial complexes (PACs) delivered at different phases of the tachycardia cycle: when a PAC is timed to His refractoriness, any perturbation of the subsequent His indicates that anterograde slow pathway conduction is involved and confirms a diagnosis of AVNRT. A PAC that advances the His potential immediately after it without terminating tachycardia indicates that retrograde fast pathway is not essential for the circuit and confirms a diagnosis of JT. This protocol was tested in 39 patients with 44 tachycardias suggesting either JT or AVNRT based on a short ventriculo-atrial interval and apparent AV node dependence. Tachycardias were divided into 3 groups: clinically obvious AVNRT, clinically obvious JT, and clinically indeterminate rhythm.
  
  
  RESULTS
  In the 26 cases of clinically obvious AVNRT, the sensitivity and specificity of the test were 61% and 100%, respectively. In the 9 cases of clinically obvious JT, the sensitivity and specificity were 100% and 100%, respectively. In the 9 cases of clinically indeterminate rhythm, the technique indicated AVNRT in 1 patient and JT in 7 patients, and the test was indeterminate in 1 patient.
  
  
  CONCLUSIONS
  The response to PACs during tachycardia can distinguish JT and AVNRT with 100% specificity in adult patients.
authors.affiliation: The Care Group, Indianapolis, Indiana, USA. bpadanil@thecaregroup.com
authors.forename: Benzy J
authors.initials: BJ
authors.lastname: Padanilam
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Manfredi
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Steinberg
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Olson
authors.forename: Richard I
authors.initials: RI
authors.lastname: Fogel
authors.forename: Eric N
authors.initials: EN
authors.lastname: Prystowsky
mesh_terms: D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods* / Q000401:mortality; D017115:Catheter Ablation / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D013613:Tachycardia, Ectopic Junctional / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome