Differentiating junctional tachycardia and atrioventricular node re-entry tachycardia based on response to atrial extrastimulus pacing.
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.
Padanilam
Benzy J
BJ
The Care Group, Indianapolis, Indiana, USA. bpadanil@thecaregroup.com
Manfredi
Joseph A
JA
Steinberg
Leonard A
LA
Olson
Jeff A
JA
Fogel
Richard I
RI
Prystowsky
Eric N
EN
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