Background
The postpacing interval (PPI) minus the tachycardia cycle length (TCL) is frequently
used to investigate tachycardias. However, a variety of issues (eg, failure to entrain,
decremental conduction, and oscillating TCLs) can make interpretation of the PPI–TCL
challenging.
Objective
The purpose of this study was to investigate a novel maneuver to confirm the PPI–TCL
value without using either the ventricular PPI or the TCL interval and to assess the
ability of this maneuver to identify decremental conduction and differentiate supraventricular
tachycardias.
Methods
We analyzed 77 intracardiac recordings from patients (age 25 ± 20 years; 40 female)
who underwent catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT)
or orthodromic reciprocating tachycardia (ORT) with a concealed pathway. We calculated
the PPI–TCL, the AH-corrected PPI–TCL, and estimated the PPI–TCL using “dual-chamber
entrainment” calculated as [PPIV – TCL = Stim(A→V) + Stim(V→A) – PPIA].
Results
The PPI–TCL calculated by dual-chamber entrainment highly correlated with the observed
and AH-corrected PPI–TCL (R2 = 0.79 and 0.96, respectively; P <.001]. A dual-chamber entrainment PPI–TCL value of 80 ms correctly differentiated
all AVNRT from septal ORT cases, whereas the standard PPI–TCL and AH-corrected PPI–TCL
methods were incorrect in 14% and 6% of cases, respectively. Dual-chamber entrainment
identified 3 ± 10 ms of additional decremental conduction beyond AH prolongation,
including 4 pathways with significant (>10 ms) decrement.
Conclusion
Dual-chamber entrainment estimates the PPI–TCL value without using either the ventricular
PPI or the TCL interval. This maneuver adjusts for all decremental conduction, including
within concealed pathways, where a dual-chamber entrainment PPI–TCL value >80 ms favors
AVNRT over ORT. This maneuver can be used to verify the observed PPI–TCL value in
challenging cases.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: November 19, 2018
Footnotes
Dr Turakhia reports grants from Janssen Inc, grants and personal fees from Medtronic Inc, grants from AstraZeneca, grants from Veterans Health Administration, other from AliveCor, personal fees from St Jude Medical, grants and personal fees from Boehringer Ingelheim, personal fees from Precision Health Economics, other from Zipline Medical, personal fees and other from iBeat Inc, personal fees from Akebia, grants and personal fees from Cardiva Medical, personal fees from Medscape/theheart.org, personal fees from Gerson Lehrman Group, personal fees from Guidepoint Global, non-financial support from Amazon, and other from iRhythm, outside the submitted work. Dr Turakhia is an editor for JAMA Cardiology. The other authors report no financial support. The authors report no relevant conflicts of interest.
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© 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
