Comparison of transesophageal and intracardiac electrophysiologic studies in characterization of supraventricular tachycardia in pediatric patients

Department of Pediatrics, Northwestern University, Children's Memorial Hospital, Chicago, Illinois, USA.

OBJECTIVES. This study sought to determine the accuracy of transesophageal electrophysiologic studies in diagnosing and characterizing various mechanisms of supraventricular tachycardia in pediatric patients. BACKGROUND. Transesophageal electrophysiologic studies are a relatively noninvasive means of characterizing supraventricular tachycardia. Although widely used, to our knowledge no data exist that directly compare information obtained from transesophageal electrophysiologic studies with that from intracardiac electrophysiologic studies. METHODS. We reviewed the records of 57 pediatric patients undergoing both transesophageal and intracardiac electrophysiologic studies at our institution. The results of these studies were compared with respect to mechanism of tachycardia, localization of accessory atrioventricular (AV) connections (if present) and characterization of anterograde accessory connection conduction properties. RESULTS. Tachycardia mechanisms were concordant in 56 of 57 patients: orthodromic reciprocating tachycardia in 43, antidromic reciprocating tachycardia in 1, both orthodromic and antidromic tachycardia in 2, AV node reentrant tachycardia in 5, atrial reentrant tachycardia in 4 and ectopic atrial tachycardia in 2. Of 29 patients with orthodromic reciprocating tachycardia using a concealed accessory connection, transesophageal study predicted the accessory connection site through changes induced by transient bundle branch block in 12. By the Bland-Altman method in 14 patients with pre-excitation, the anterograde accessory connection effective refractory period determined by transesophageal study compared favorably with that determined by intracardiac study (mean difference 5.0 ms, limits of agreement -55 and 65 ms). CONCLUSIONS. Transesophageal electrophysiologic studies are a highly accurate means of diagnosing and characterizing various mechanisms of supraventricular tachycardia in pediatric patients.

This article has been cited by other articles:

				B. Brembilla-Perrot, F. Chometon, L. Groben, C. Tatar, J.-D. Luporsi, J. Bertrand, O. Huttin, D. Beurrier, S. Ammar, J. Cedano, et al. Are the results of electrophysiological study different in patients with a pre-excitation syndrome, with and without syncope? Europace, February 1, 2008; 10(2): 175 - 180. [Abstract] [Full Text] [PDF]

				B. Brembilla-Perrot, F. Chometon, L. Groben, S. Ammar, J. Bertrand, C. Marcha, J.L. Cloez, A. Tisserand, O. Huttin, C. Tatar, et al. Interest of non-invasive and semi-invasive testings in asymptomatic children with pre-excitation syndrome Europace, September 1, 2007; 9(9): 837 - 843. [Abstract] [Full Text] [PDF]

				J. F. Strasburger, B. F. Cuneo, M. M. Michon, N. L. Gotteiner, B. J. Deal, S. N. McGregor, M. A. Oudijk, E. J. Meijboom, L. Feinkind, M. Hussey, et al. Amiodarone Therapy for Drug-Refractory Fetal Tachycardia Circulation, January 27, 2004; 109(3): 375 - 379. [Abstract] [Full Text] [PDF]

				T. Kohl, P. F. Kirchhof, W. Gogarten, J. Reckers, B. Asfour, R. Witteler, W. Haverkamp, L. Eckardt, A. E. Marcus, H. VanAken, et al. Fetoscopic Transesophageal Electrocardiography and Stimulation in Fetal Sheep : A Minimally Invasive Approach Aimed at Diagnosis and Termination of Therapy-Refractory Supraventricular Tachycardias in Human Fetuses Circulation, August 17, 1999; 100(7): 772 - 776. [Abstract] [Full Text] [PDF]

				K. Nanthakumar, L. Bergfeldt, and B. Darpo Assessment of accessory pathway and atrial refractoriness by transoesophageal and intracardiac atrial stimulation: An analysis of methodological agreement Europace, January 1, 1999; 1(1): 55 - 62. [Abstract] [PDF]