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A technique for diagnosis of accessory pathway using the H-H and A-A intervals of the first entrained cycle during ventricular overdrive pacing. | LitMetric

A technique for diagnosis of accessory pathway using the H-H and A-A intervals of the first entrained cycle during ventricular overdrive pacing.

Am J Cardiol

Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.

Published: July 2008

AI Article Synopsis

  • - The study explores the effectiveness of using His-His (H-H) and atrial-atrial (A-A) intervals during ventricular overdrive pacing (VOD) as a means to diagnose accessory pathways (AP) in patients with supraventricular tachycardia (SVT) compared to the traditional ventricular extrastimulus (VES) method.
  • - In a sample of 55 SVT patients, the results showed that while VES advanced atrial activation in 52% of patients with AP, it did not occur in any without AP, indicating its limited sensitivity.
  • - The new criterion, where the H-H interval exceeded the A-A interval by 15 ms, demonstrated a diagnostic success rate

Article Abstract

Although advancement of succeeding atrial activation by a ventricular extrastimulus (VES) on His refractoriness during supraventricular tachycardia (SVT) has been used as evidence of an accessory pathway (AP), the sensitivity of this method is suboptimal. This study was designed to compare the His-His (H-H) and atrial-atrial (A-A) intervals of the first entrained cycle during ventricular overdrive pacing (VOD) for the diagnosis of AP, in comparison to the conventional VES method. In 55 patients with SVT, a VES was elicited on His refractoriness during SVT. VOD was subsequently performed at cycle lengths 30 to 40 ms shorter than SVT cycle lengths. When the A-A interval became equal to the pacing cycle length after some beats of VOD, the cycle was considered the first entrained cycle and the H-H interval preceding the A-A interval was measured. VES advanced the next atrial activation in 16 patients (52%) with an AP, but in no patient without an AP. The H-H interval of the first entrained cycle was longer than the pacing cycle length by > or =15 ms in all patients with an AP, but was equal to the pacing cycle length in all patients without an AP. The criterion of H-H greater than A-A by > or =15 ms for the first entrained cycle provided higher diagnostic yield for AP compared with the VES method(100% vs 52%, p <0.001). In conclusion, this new criterion reliably diagnoses the presence of an AP in patients with SVT, with higher sensitivity compared with the VES method.

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Source
http://dx.doi.org/10.1016/j.amjcard.2008.03.036DOI Listing

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