Heart rhythm · 2026
Line of block: A simple pacing maneuver to distinguish AV nodal from accessory pathway ventriculoatrial conduction.
СтатьяНазвание и аннотация: Перевод в очереди
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Mokhtar Ahmed T, Skanes Allan C, Leong-Sit Peter, Tang Anthony S L, Klein George J, Antiperovitch Pavel
Аннотация
BACKGROUND: Septal accessory pathways (APs), including concealed APs can be difficult to diagnose using standard electrophysiology (EP) maneuvers. We introduce a simple technique using the "line of block" concept that can potentially added to the list of standard maneuvers in cases where the presence of a septal AP is suspected.
OBJECTIVE: This study aimed to determine the efficacy of the "line of block" concept among patients with septal APs using a reproducible and simple technique.
METHODS: An exploratory catheter is used to pace the basal right ventricle, and the stimulus-to-atrial interval at pacing site 1 (SA1) is measured. The exploratory catheter is then moved 2-3 cm deeper into the right ventricle toward the apex, and the stimulus-to-atrial interval at pacing site 2 (SA2) is measured. The results (SA1 > SA2 = nodal response vs SA1 < SA2 = AP response) were determined. The technique can also be done during entrainment of ongoing tachycardia.
RESULTS: 24 patients undergoing an EP study fulfilled the criteria for enrollment and were included in the study between October 2023 and April 2025. 10 patients (41.7%) had proven APs, while 14 patients (58.3%) had none. The mean SA1-SA2 for patients with proven AP was 19.4 msec (standard deviation ± 9.2), whereas the mean SA1-SA2 for patients without an AP was 10.5 msec (standard deviation ± 10.5). All patients with AP demonstrated an SA1-SA2 less than 0 msec, whereas the reverse was true among patients with no demonstrable AP.
CONCLUSION: Using the "line of block" concept by determining the ΔSA1-SA2 allows for easy determination to the presence or absence of an AP. Larger studies and sample sizes are required to allow for universal application in other EP labs.
OBJECTIVE: This study aimed to determine the efficacy of the "line of block" concept among patients with septal APs using a reproducible and simple technique.
METHODS: An exploratory catheter is used to pace the basal right ventricle, and the stimulus-to-atrial interval at pacing site 1 (SA1) is measured. The exploratory catheter is then moved 2-3 cm deeper into the right ventricle toward the apex, and the stimulus-to-atrial interval at pacing site 2 (SA2) is measured. The results (SA1 > SA2 = nodal response vs SA1 < SA2 = AP response) were determined. The technique can also be done during entrainment of ongoing tachycardia.
RESULTS: 24 patients undergoing an EP study fulfilled the criteria for enrollment and were included in the study between October 2023 and April 2025. 10 patients (41.7%) had proven APs, while 14 patients (58.3%) had none. The mean SA1-SA2 for patients with proven AP was 19.4 msec (standard deviation ± 9.2), whereas the mean SA1-SA2 for patients without an AP was 10.5 msec (standard deviation ± 10.5). All patients with AP demonstrated an SA1-SA2 less than 0 msec, whereas the reverse was true among patients with no demonstrable AP.
CONCLUSION: Using the "line of block" concept by determining the ΔSA1-SA2 allows for easy determination to the presence or absence of an AP. Larger studies and sample sizes are required to allow for universal application in other EP labs.