Heart rhythm · 2008
Single diagnostic pacing maneuver for supraventricular tachycardia.
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Veenhuyzen George D, Coverett Kelly, Quinn F Russell, Sapp John L, Gillis Anne M, Sheldon Robert, Exner Derek V, Mitchell L Brent
Аннотация
BACKGROUND: Diagnostic supraventricular tachycardia (SVT) features and pacing maneuvers tend to be specific but insensitive. Therefore, diagnosis often requires the integration of multiple pieces of information and/or pacing maneuvers, which adds to the complexity of catheter ablation procedures.
OBJECTIVE: The purpose of this study was to determine if a single diagnostic pacing maneuver, namely, ventricular overdrive pacing including a basal pacing site near the earliest atrial activation, provides a definitive SVT diagnosis in nearly all patients.
METHODS: Sixty-seven consecutive patients with SVT undergoing catheter ablation at two institutions were prospectively studied.
RESULTS: Overdrive ventricular pacing provided the correct diagnosis in 91% of all patients and in 100% of patients when pacing accelerated the atrium to the pacing cycle length. Fusion due to wavefront collision in the ventricles or distal conduction system was 73% sensitive and 100% specific for accessory pathway-mediated SVT. Basal pacing was superior to pacing from the right ventricular apex for distinguishing accessory pathway-mediated SVT from AV nodal reentrant tachycardia.
CONCLUSION: Overdrive ventricular pacing is a highly effective single diagnostic pacing maneuver for sustained SVT. Basal pacing sites near the earliest atrial activation are superior to the right ventricular apex.
OBJECTIVE: The purpose of this study was to determine if a single diagnostic pacing maneuver, namely, ventricular overdrive pacing including a basal pacing site near the earliest atrial activation, provides a definitive SVT diagnosis in nearly all patients.
METHODS: Sixty-seven consecutive patients with SVT undergoing catheter ablation at two institutions were prospectively studied.
RESULTS: Overdrive ventricular pacing provided the correct diagnosis in 91% of all patients and in 100% of patients when pacing accelerated the atrium to the pacing cycle length. Fusion due to wavefront collision in the ventricles or distal conduction system was 73% sensitive and 100% specific for accessory pathway-mediated SVT. Basal pacing was superior to pacing from the right ventricular apex for distinguishing accessory pathway-mediated SVT from AV nodal reentrant tachycardia.
CONCLUSION: Overdrive ventricular pacing is a highly effective single diagnostic pacing maneuver for sustained SVT. Basal pacing sites near the earliest atrial activation are superior to the right ventricular apex.