When and how does a single ventricular premature beat initiate and terminate supraventricular tachycardia?. Issue 5 (16th April 2019)

• Record Type: Journal Article
• Authors: Cunha Guerra, Magno; Lokhandwala, Yash; Oyarzun, Rodulfo; Vyas, Aniruddha; Soares Correa, Frederico; Cruz Filho, Fernando Eugenio; J.Wellens, Hein; Back Sternick, Eduardo
• Is Part Of: Annals of noninvasive electrocardiology. Volume 24:Issue 5(2019:Sep.)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-04-16
• Subjects: cardiac rhythm event recorders -- electrophysiologic study -- supraventricular tachycardia -- tachycardia mechanisms; Electrocardiography -- Periodicals; Arrhythmia -- Periodicals; 616.1207547
• DOI: 10.1111/anec.12650
• Languages: English
• ISSNs: 1082-720X

Abstract

Abstract: Background: The differential diagnosis of a supraventricular tachycardia (SVT) is accomplished using a number of pacing maneuvers. The incidence and mechanism of a single ventricular premature beat (VPB) on initiation and termination of tachycardia were evaluated during programmed electrical stimulation (PES) of the heart in patients with the two most common regular SVTs: atrioventricular re‐entrant tachycardia (AVNRT) and orthodromic atrioventricular tachycardia (AVRT). Methods: Three hundred and thirty‐seven consecutive patients aged above 18 years with an inducible sustained AVNRT or AVRT were prospectively enrolled. Patients with more than one tachyarrhythmia mechanism were excluded. Two hundred and seventeen patients (64.4%) had typical slow/fast AVNRT and 120 (35.6%) had an orthodromic AVRT using a rapidly conducting accessory pathway for V‐A conduction. In this cross‐sectional study, we specifically report the analysis of tachycardia induction and termination by a single VPB. Results: Tachycardia induction with a single VPB during sinus rhythm was seen in 7 of 120 AVRT and in only one of the 217 patients with AVNRT, (5.8% vs. 0.3%, p < 0.05). When a single VPB was delivered during basic ventricular pacing these values were 28% versus 4%, respectively, ( p < 0.001). Termination of tachycardia by a single VPB was observed in nine (4.1%) patients with AVNRT and in 57 (47.5%) with AVRT ( p < 0.001). Conclusion: Initiation of SVT by a single VPB during sinus rhythm was uncommon and favored AVRT. Termination of SVT by a single VPB was commonly seen in AVRT but rarely in AVNRT. These findings can be of help when interpreting a noninvasive arrhythmia event recording.