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CLINICAL STUDY

Differentiation of atypical atrioventricular node re-entrant tachycardia from orthodromic reciprocating tachycardia using a septal accessory pathway by the response to ventricular pacing

Gregory F. Michaud, MD, FACC^*, Hiroshi Tada, MD, Steven Chough, MD, Robert Baker, MD, Kristina Wasmer, MD, Christian Sticherling, MD, Hakan Oral, MD, Frank Pelosi, Jr, MD, Bradley P. Knight, MD, FACC, S. Adam Strickberger, MD, FACC and Fred Morady, MD, FACC

^* Division of Cardiology, Department of Internal Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
University of Michigan Medical Center, Ann Arbor, Michigan, USA

Manuscript received October 18, 2000; revised manuscript received May 24, 2001, accepted June 14, 2001.

Reprint requests and correspondence: Dr. Gregory F. Michaud, Division of Cardiology, Rhode Island Hospital, 2 Dudley Street, Suite 360, Providence, Rhode Island 02905
gmichaud{at}lifespan.org

OBJECTIVES

The purpose of this study was to determine whether the response to ventricular pacing during tachycardia is useful for differentiating atypical atrioventricular node re-entrant tachycardia (AVNRT) from orthodromic reciprocating tachycardia (ORT) using a septal accessory pathway.

BACKGROUND

Although it is usually possible to differentiate atypical AVNRT from ORT using a septal accessory pathway, a definitive diagnosis is occasionally elusive.

METHODS

In 30 patients with atypical AVNRT and 44 patients with ORT using a septal accessory pathway, the right ventricle was paced at a cycle length 10 to 40 ms shorter than the tachycardia cycle length (TCL). The ventriculo-atrial (VA) interval and TCL were measured just before pacing. The interval between the last pacing stimulus and the last entrained atrial depolarization (stimulus-atrial [S-A] interval) and the post-pacing interval (PPI) at the right ventricular apex were measured on cessation of ventricular pacing.

RESULTS

All 30 patients with atypical AVNRT and none of the 44 patients with ORT using a septal accessory pathway had an S-A–VA interval >85 ms and PPI–TCL >115 ms.

CONCLUSIONS

The S-A–VA interval and PPI–TCL are useful in distinguishing atypical AVNRT from ORT using a septal accessory pathway.

Abbreviations and Acronyms   AAV = atrial-atrial-ventricular   AH = atrial-His bundle   AV = atrial-ventricular   AVNRT = atrioventricular node re-entrant tachycardia   HA = His-atrial   ORT = orthodromic reciprocating tachycardia   PPI = post-pacing interval   RV = right ventricle or ventricular   S-A = stimulus-atrial   TCL = tachycardia cycle length   VA = ventriculo-atrial

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