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Journal of the American College of... Nov 2008The purpose of this study was to differentiate non-re-entrant junctional tachycardia (JT) and typical atrioventricular node re-entry tachycardia (AVNRT). (Comparative Study)
Comparative Study
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.
Topics: Adult; Aged; Cardiac Pacing, Artificial; Catheter Ablation; Cohort Studies; Diagnosis, Differential; Electrocardiography; Electrophysiologic Techniques, Cardiac; Female; Follow-Up Studies; Heart Conduction System; Humans; Male; Middle Aged; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Survival Analysis; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Ectopic Junctional; Treatment Outcome
PubMed: 19007691
DOI: 10.1016/j.jacc.2008.08.030 -
Hellenic Journal of Cardiology : HJC =... 2012The implantable cardioverter-defibrillator (ICD) has been proven to reduce the mortality of patients with life-threatening ventricular arrhythmias, and has become the...
The implantable cardioverter-defibrillator (ICD) has been proven to reduce the mortality of patients with life-threatening ventricular arrhythmias, and has become the therapy of choice for patients with aborted sudden cardiac death or poorly tolerated ventricular tachycardias. Abrupt changes in ventricular cycle lengths or short-long-short (S-L-S) sequences might precede the initiation of ventricular tachycardia and ventricular fibrillation. The S-L-S sequences might be passively permitted or actively facilitated by pacing. We present a case of ICD-facilitated ventricular tachycardia.
Topics: Atrial Fibrillation; Cardiac Pacing, Artificial; Defibrillators, Implantable; Electrocardiography; Humans; Male; Middle Aged; Tachycardia, Ventricular
PubMed: 22796822
DOI: No ID Found -
Indian Heart Journal 2021One of the most critical and challenging skills is the distinction of wide complex tachycardias into ventricular tachycardia or supraventricular wide complex... (Review)
Review
One of the most critical and challenging skills is the distinction of wide complex tachycardias into ventricular tachycardia or supraventricular wide complex tachycardia. Prompt and accurate differentiation of wide complex tachycardias naturally influences short- and long-term management decisions and may directly affect patient outcomes. Currently, there are many useful electrocardiographic criteria and algorithms designed to distinguish ventricular tachycardia and supraventricular wide complex tachycardia accurately; however, no single approach guarantees diagnostic certainty. In this review, we offer an in-depth analysis of available methods to differentiate wide complex tachycardias by retrospectively examining its rich literature base - one that spans several decades.
Topics: Algorithms; Diagnosis, Differential; Electrocardiography; Humans; Tachycardia, Ventricular
PubMed: 33714412
DOI: 10.1016/j.ihj.2020.09.006 -
Revista Portuguesa de Cardiologia Mar 2018We present the case of a previously healthy 42-year-old man who attended the emergency department due to a sudden onset of rapid and regular palpitations. The ECG showed...
We present the case of a previously healthy 42-year-old man who attended the emergency department due to a sudden onset of rapid and regular palpitations. The ECG showed 190 bpm, wide QRS with left bundle branch block tachycardia. He was started on amiodarone with progression to 230 bpm, wide QRS tachycardia with multiple morphologies, followed by spontaneous conversion to sinus rhythm, normal PR interval and rS pattern in LIII. The echocardiogram was negative for structural heart disease. The electrophysiological study demonstrated the presence of an accessory pathway with anterograde decremental conduction and no retrograde conduction. Both episodes of clinical tachycardia were induced. A diagnosis of Mahaim fiber-mediated antidromic atrioventricular reentrant tachycardia and pre-excited atrial fibrillation was made. Mapping was performed with detection of an M potential (His-like) at the lateral region of the tricuspid ring followed by radiofrequency ablation with immediate success criteria. Post-ablation there was a change to a qR pattern in LIII. At 12-months follow-up there was no recurrence of the tachycardia.
Topics: Accessory Atrioventricular Bundle; Adult; Electrocardiography; Humans; Male; Tachycardia
PubMed: 29622376
DOI: 10.1016/j.repc.2017.01.008 -
Journal of the American Heart... Jun 2020The primary goal of the initial ECG evaluation of every wide complex tachycardia is to determine whether the tachyarrhythmia has a ventricular or supraventricular... (Review)
Review
The primary goal of the initial ECG evaluation of every wide complex tachycardia is to determine whether the tachyarrhythmia has a ventricular or supraventricular origin. The answer to this question drives immediate patient care decisions, ensuing clinical workup, and long-term management strategies. Thus, the importance of arriving at the correct diagnosis cannot be understated and has naturally spurred rigorous research, which has brought forth an ever-expanding abundance of manually applied and automated methods to differentiate wide complex tachycardias. In this review, we provide an in-depth analysis of traditional and more contemporary methods to differentiate ventricular tachycardia and supraventricular wide complex tachycardia. In doing so, we: (1) review hallmark wide complex tachycardia differentiation criteria, (2) examine the conceptual and structural design of standard wide complex tachycardia differentiation methods, (3) discuss practical limitations of manually applied ECG interpretation approaches, and (4) highlight recently formulated methods designed to differentiate ventricular tachycardia and supraventricular wide complex tachycardia automatically.
Topics: Action Potentials; Animals; Diagnosis, Differential; Electrocardiography; Electrophysiologic Techniques, Cardiac; Heart Conduction System; Heart Rate; Humans; Predictive Value of Tests; Tachycardia, Supraventricular; Tachycardia, Ventricular; Time Factors
PubMed: 32427020
DOI: 10.1161/JAHA.120.016598 -
Clinical Cardiology Jun 2005Sinus tachycardia is the most common rhythm disturbance encountered in clinical practice. Primary sinus tachycardia without an underlying secondary cause, despite often... (Review)
Review
Sinus tachycardia is the most common rhythm disturbance encountered in clinical practice. Primary sinus tachycardia without an underlying secondary cause, despite often being associated with troublesome symptoms, is often neglected leading to multiple consultations and frustration on part of both the practitioner and the patient. The fact that primary sinus tachycardias are a heterogeneous group of disorders is seldom appreciated; hence, a firm diagnosis is rarely reached and management is haphazard. Furthermore, there may be prognostic implications for prolonged or recurrent sinus tachycardia, making it imperative that this group of arrhythmias receive adequate and appropriate attention. Normal sinus tachycardia (i.e., secondary), inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome (POTS) and sinus node reentry tachycardia make up this group of arrhythmias. Their definitions, clinical features, diagnostic criteria, pathophysiologic mechanisms, and optimum management are discussed in this review.
Topics: Diagnosis, Differential; Electrocardiography; Heart Rate; Humans; Tachycardia, Sinus
PubMed: 16028460
DOI: 10.1002/clc.4960280603 -
JACC. Clinical Electrophysiology Nov 2022The entrainment response, defined as the difference between the postpacing interval and the tachycardia cycle length (TCL) recorded from a mapping catheter, allows to...
BACKGROUND
The entrainment response, defined as the difference between the postpacing interval and the tachycardia cycle length (TCL) recorded from a mapping catheter, allows to track down the components of the tachycardia loop.
OBJECTIVES
The aim of this study was to evaluate if the postpacing interval measured simultaneously from multiple sites that are remote from the pacing site (PPIR) could be clinically useful in mapping re-entrant circuits.
METHODS
Ninety-two episodes of entrainment response in 29 patients with different macro-re-entrant tachycardias were evaluated using a standardized entrainment protocol. The spatial distribution of different values of PPIR-TCL in a simulation and a computational model of an entrained re-entrant tachycardia was also analyzed.
RESULTS
The PPIR exceeded TCL by more than 20 milliseconds only if both pacing and recording sites were outside the tachycardia circuit. The PPIR-TCL at in-circuit sites was always ≤20 milliseconds. Sites with negative PPIR-TCL values were found either outside or inside the tachycardia circuit.
CONCLUSIONS
Assessment of entrainment response from catheters remote from the pacing site may enhance spatial mapping of the tachycardia circuit. The PPIR-TCL above 20 milliseconds has an excellent positive predictive value in identifying sites outside the tachycardia circuit.
Topics: Humans; Heart Conduction System; Cardiac Pacing, Artificial; Tachycardia, Atrioventricular Nodal Reentry; Computer Simulation; Predictive Value of Tests
PubMed: 36424006
DOI: 10.1016/j.jacep.2022.07.013 -
Current Cardiology Reviews 2015One of the most important proarrhythmic complications after left atrial (LA) ablation is regular atrial tachycardia (AT) or flutter. Those tachycardias that occur after... (Review)
Review
One of the most important proarrhythmic complications after left atrial (LA) ablation is regular atrial tachycardia (AT) or flutter. Those tachycardias that occur after atrial fibrillation (AF) ablation can cause even more severe symptoms than those from the original arrhythmia prior to the index ablation procedure since they are often incessant and associated with rapid ventricular response. Depending on the method and extent of LA ablation and on the electrophysiological properties of underlying LA substrate, the reported incidence of late ATs is variable. To establish the exact mechanism of these tachycardias can be difficult and controversial but correlates with the ablation technique and in the vast majority of cases the mechanism is reentry related to gaps in prior ablation lines. When tachycardias occur, conservative therapy usually is not effective, radiofrequency ablation procedure is mostly successful, but can be challenging, and requires a complex approach.
Topics: Atrial Fibrillation; Catheter Ablation; Electrocardiography; Heart Atria; Humans; Tachycardia
PubMed: 25308808
DOI: 10.2174/1573403x10666141013122400 -
Lakartidningen Oct 2018
Topics: Checklist; Critical Pathways; Defibrillators; Electric Countershock; Heart Arrest; Humans; Tachycardia
PubMed: 30672681
DOI: No ID Found -
Europace : European Pacing,... Feb 2023
Topics: Humans; Hospital Mortality; Tachycardia, Supraventricular; Arrhythmias, Cardiac; Catheter Ablation
PubMed: 36305555
DOI: 10.1093/europace/euac180