CLINICAL RESEARCH: HEART RHYTHM DISORDER
Differentiating Junctional Tachycardia and Atrioventricular Node Re-Entry Tachycardia Based on Response to Atrial Extrastimulus Pacing
Benzy J. Padanilam, MD, FACC*,
Joseph A. Manfredi, MD,
Leonard A. Steinberg, MD,
Jeff A. Olson, DO,
Richard I. Fogel, MD, FACC and
Eric N. Prystowsky, MD, FACC
The Care Group, Indianapolis, Indiana
Manuscript received May 22, 2008;
revised manuscript received July 31, 2008,
accepted August 4, 2008.
* Reprint requests and correspondence: Dr. Benzy J. Padanilam, 8333 Naab Road, #400, Indianapolis, Indiana 46260 (Email: bpadanil{at}thecaregroup.com).
Objectives: The purpose of this study was to differentiate non–re-entrant junctional tachycardia (JT) and typical atrioventricular node re-entry tachycardia (AVNRT).
Background: JT may mimic AVNRT. Ablation of JT is associated with a lower success rate and a higher incidence of heart block. Electrophysiologic differentiation of these tachycardias is often difficult.
Methods: We hypothesized that JT can be distinguished from AVNRT based on specific responses to premature atrial complexes (PACs) delivered at different phases of the tachycardia cycle: when a PAC is timed to His refractoriness, any perturbation of the subsequent His indicates that anterograde slow pathway conduction is involved and confirms a diagnosis of AVNRT. A PAC that advances the His potential immediately after it without terminating tachycardia indicates that retrograde fast pathway is not essential for the circuit and confirms a diagnosis of JT. This protocol was tested in 39 patients with 44 tachycardias suggesting either JT or AVNRT based on a short ventriculo-atrial interval and apparent AV node dependence. Tachycardias were divided into 3 groups: clinically obvious AVNRT, clinically obvious JT, and clinically indeterminate rhythm.
Results: In the 26 cases of clinically obvious AVNRT, the sensitivity and specificity of the test were 61% and 100%, respectively. In the 9 cases of clinically obvious JT, the sensitivity and specificity were 100% and 100%, respectively. In the 9 cases of clinically indeterminate rhythm, the technique indicated AVNRT in 1 patient and JT in 7 patients, and the test was indeterminate in 1 patient.
Conclusions: The response to PACs during tachycardia can distinguish JT and AVNRT with 100% specificity in adult patients.
Key Words: junctional tachycardia • atrioventricular node re-entry • premature atrial complex • catheter ablation
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Abbreviations and Acronyms
| | AV = atrioventricular | | AVNRT = atrioventricular node re-entry tachycardia | | EP = electrophysiology | | HRA = high right atrium | | JT = junctional tachycardia | | PAC = premature atrial complex |
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Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 52: A33.
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