title: His overdrive pacing during supraventricular tachycardia: a novel maneuver for distinguishing atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia.
abstract: BACKGROUND
  Because the His bundle is intrinsic to the circuit in orthodromic reciprocating tachycardia and remote from that of atrioventricular nodal reentrant tachycardia (AVNRT), pacing the His bundle during supraventricular tachycardia (SVT) may be useful to distinguish these arrhythmias.
  
  
  OBJECTIVE
  The purpose of this study was to test the hypothesis that His overdrive pacing (HOP) would affect SVT immediately for orthodromic reciprocating tachycardia and in a delayed manner for AVNRT.
  
  
  METHODS
  Once SVT was induced, HOP was performed by pacing the His bundle 10-30 ms faster than the SVT cycle length. The maneuver was determined to have entered the tachycardia circuit when a nonfused His-capture beat advanced or delayed the subsequent atrial electrogram by ≥10 ms or when the tachycardia was terminated. The number of beats required to enter each tachycardia with HOP was recorded.
  
  
  RESULTS
  HOP was performed during 66 SVTs (26 atrioventricular reciprocating tachycardia [AVRT] and 40 AVNRT). Entry into the tachycardia within 1 beat had sensitivity of 92%, specificity of 92%, positive predictive value (PPV) of 89% and negative predictive value (NPV) of 95% to confirm the diagnosis of AVRT. A cutoff ≥3 beats to enter the circuit had sensitivity of 90%, specificity of 92%, PPV of 95% and NPV of 86% to confirm the diagnosis of AVNRT. HOP had sensitivity, specificity, PPV, and NPV of 100% for distinguishing septal AVRT from atypical AVNRT.
  
  
  CONCLUSIONS
  HOP during SVT is a novel technique for distinguishing orthodromic reciprocating tachycardia from AVNRT. It can reliably distinguish between these arrhythmias with high sensitivity and specificity.
authors.affiliation: Division of Cardiology, Queens Medical Center, Honolulu, Hawaii. Electronic address: dsingh@queens.org.
authors.forename: David K
authors.initials: DK
authors.lastname: Singh
authors.affiliation: Division of Cardiology, University of Washington, Seattle, Washington.
authors.forename: Mohan N
authors.initials: MN
authors.lastname: Viswanathan
authors.affiliation: Division of Pediatric Cardiology, University of California San Francisco, San Francisco, California.
authors.forename: Ronn E
authors.initials: RE
authors.lastname: Tanel
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Lee
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Byron K
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Marcus
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Olgin
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Frederick
authors.initials: F
authors.lastname: Han
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Vasanth
authors.initials: V
authors.lastname: Vedantham
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Zian H
authors.initials: ZH
authors.lastname: Tseng
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Cara
authors.initials: C
authors.lastname: Pellegrini
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Kawamura
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Nitish
authors.initials: N
authors.lastname: Badhwar
authors.affiliation: Division of Electrophysiology, University of California San Francisco, San Francisco, California.
authors.forename: Melvin
authors.initials: M
authors.lastname: Scheinman
mesh_terms: D000293:Adolescent; D000328:Adult; D002036:Bundle of His / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D054139:Tachycardia, Reciprocating / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D055815:Young Adult
keywords: Ablation; Atrioventricular nodal reentrant tachycardia; Atrioventricular reciprocating tachycardia; Entrainment; Supraventricular tachycardia