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CLINICAL STUDIES

Diagnostic value of tachycardia features and pacing maneuvers during paroxysmal supraventricular tachycardia

^a Department of Internal Medicine, Division of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA

Manuscript received September 7, 1999; revised manuscript received February 16, 2000, accepted March 30, 2000.

Reprint requests and correspondence: Dr. Bradley P. Knight, University of Michigan Health System, 1500 East Medical Center Drive/B1F245, Ann Arbor, Michigan 48109-0022
bpk{at}umich.edu

OBJECTIVES

The purpose of this prospective study was to quantitate the diagnostic value of several tachycardia features and pacing maneuvers in patients with paroxysmal supraventricular tachycardia (PSVT) in the electrophysiology laboratory.

BACKGROUND

No study has prospectively compared the value of multiple diagnostic tools in a large group of patients with PSVT.

METHODS

One hundred ninety-six consecutive patients who had 200 inducible sustained PSVTs during an electrophysiology procedure were included. The diagnostic values of four baseline electrophysiologic parameters, nine tachycardia features and five diagnostic pacing maneuvers were quantified.

RESULTS

The only tachycardia characteristic that was diagnostic of atrioventricular (AV) nodal reentry was a septal ventriculoatrial (VA) time of <70 ms, and no pacing maneuver was diagnostic for AV nodal reentry. An increase in the VA interval with the development of a bundle branch block was the only tachycardia characteristic that was diagnostic for orthodromic tachycardia, but it occurred in only 7% of all tachycardias. An atrial-atrial-ventricular response upon cessation of ventricular overdrive pacing was diagnostic of atrial tachycardia, and this maneuver could be applied to 78% of all tachycardias. Burst ventricular pacing excluded atrial tachycardia when the tachycardia terminated without depolarization of the atrium, but the result could be obtained only in 27% of patients.

CONCLUSIONS

This prospective study quantitates the diagnostic value of multiple observations and pacing maneuvers that are commonly used during PSVT in the electrophysiology laboratory. The findings demonstrate that diagnostic techniques rarely provide a diagnosis when used individually. Therefore, careful observations and multiple pacing maneuvers are often required for an accurate diagnosis during PSVT. The results of this study provide a useful reference with which new diagnostic techniques can be compared.

Abbreviations and Acronyms   AH = atrial His bundle   AV = atrioventricular   ECG = electrocardiogram, electrocardiographic   PSVT = paroxysmal supraventricular tachycardia   VA = ventriculoatrial

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