A novel pacing maneuver to verify the postpacing interval minus the tachycardia cycle length while adjusting for decremental conduction: Using "dual-chamber entrainment" for improved supraventricular tachycardia discrimination.
A novel pacing maneuver to verify the postpacing interval minus the tachycardia cycle length while adjusting for decremental conduction: Using "dual-chamber entrainment" for improved supraventricular tachycardia discrimination.
复制标题
一种新颖的起搏操作，用于验证起搏后间隔减去心动过速周期长度，同时调整递减传导：使用“双腔夹带”改善室上性心动过速辨别。
DOI：
10.1016/j.hrthm.2018.11.021
复制
发表时间：
2019
期刊：
影响因子：
5.5
通讯作者：
Dubin,AnneM
中科院分区：
文献类型：
--
作者：
Kaiser,DanielW;Nasir,JavedM;Liem,LBing;Brodt,Chad;Motonaga,KaraS;Ceresnak,ScottR;Turakhia,MintuP;Dubin,AnneM
BackgroundThe postpacing interval (PPI) minus the tachycardia cycle length (TCL) is frequently used to investigate tachycardias. However, a variety of issues (eg, failure to entrain, decremental conduction, and oscillating TCLs) can make interpretation of the PPI–TCL challenging.ObjectiveThe purpose of this study was to investigate a novel maneuver to confirm the PPI–TCL value without using either the ventricular PPI or the TCL interval and to assess the ability of this maneuver to identify decremental conduction and differentiate supraventricular tachycardias.MethodsWe analyzed 77 intracardiac recordings from patients (age 25 ± 20 years; 40 female) who underwent catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) or orthodromic reciprocating tachycardia (ORT) with a concealed pathway. We calculated the PPI–TCL, the AH-corrected PPI–TCL, and estimated the PPI–TCL using “dual-chamber entrainment” calculated as [PPIV– TCL = Stim(A→V) + Stim(V→A) – PPIA].ResultsThe PPI–TCL calculated by dual-chamber entrainment highly correlated with the observed and AH-corrected PPI–TCL (R2= 0.79 and 0.96, respectively;P<.001]. A dual-chamber entrainment PPI–TCL value of 80 ms correctly differentiated all AVNRT from septal ORT cases, whereas the standard PPI–TCL and AH-corrected PPI–TCL methods were incorrect in 14% and 6% of cases, respectively. Dual-chamber entrainment identified 3 ± 10 ms of additional decremental conduction beyond AH prolongation, including 4 pathways with significant (>10 ms) decrement.ConclusionDual-chamber entrainment estimates the PPI–TCL value without using either the ventricular PPI or the TCL interval. This maneuver adjusts for all decremental conduction, including within concealed pathways, where a dual-chamber entrainment PPI–TCL value >80 ms favors AVNRT over ORT. This maneuver can be used to verify the observed PPI–TCL value in challenging cases.
