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Diagnostic utility of early premature ventricular complexes in differentiating atrioventricular reentrant and atrioventricular nodal reentrant tachycardias

      Background

      His-refractory premature ventricular complexes perturbing a supraventricular tachycardia (SVT) establish the presence of an accessory pathway (AP). Earlier premature ventricular complexes (ErPVCs) may perturb SVTs but are considered nondiagnostic.

      Objective

      The purpose of this study was to test the hypothesis that an ErPVC will always show a difference >35 ms in its advancement of the next atrial activation during atrioventricular nodal reentrant tachycardia (AVNRT). During atrioventricular reentrant tachycardia (AVRT), a PVC delivered close to the circuit can result in greater advancement of atrial activation due to retrograde conduction via an AP. Thus, an AP response, defined as ErPVC (H1S2) advancing the subsequent atrial activation (A1-A2) more than this minimum difference (A1A2 ≤ H1S2+35 ms), establishes the presence of an AP.

      Methods

      Sixty-five consecutive patients with SVT were retrospectively evaluated. ErPVCs were defined when the ventricular pacing stimulus was >35 ms ahead of the His during tachycardia.

      Results

      Among the 65 cases, 43 were AVNRT and 22 AVRT. Fourteen AVRT cases had an AP response with a mean H1S2+35 ms of 336 ± 58 ms and A1A2 of 309 ± 51ms. No AVNRT cases had an AP response. The specificity of an AP response to ErPVC in predicting AVRT was 100%.

      Conclusion

      An AP response to PVCs (A1A2 ≤ H1S2+35 ms) is 100% specific for the presence of an AP.

      Graphical abstract

      Key Words

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      References

        • Josephson M.E.
        Josephson's Clinical Cardiac Electrophysiology: Techniques and Interpretations.
        Fifth Edition. Wolters Kluwer Health, 2016
        • Padanilam B.J.
        • Ahmed A.S.
        • Clark B.A.
        • et al.
        Differentiating atrioventricular reentry tachycardia and atrioventricular node reentry tachycardia using premature his bundle complexes.
        Circ Arrhythm Electrophysiol. 2020; 13e007796
        • Zipes D.P.
        • DeJoseph R.L.
        • Rothbaum D.A.
        Unusual properties of accessory pathways.
        Circulation. 1974; : 491200-491211
        • Sellers Jr., T.D.
        • Gallagher J.J.
        • Cope G.D.
        • Tonkin A.M.
        • Wallace A.G.
        Retrograde atrial preexcitation following premature ventricular beats during reciprocating tachycardia in the Wolff-Parkinson-White syndrome.
        Eur J Cardiol. 1976; 4: 283-294
        • Miles W.M.
        • Yee R.
        • Klein G.J.
        • Zipes D.P.
        • Prystowsky E.N.
        The preexcitation index: an aid in determining the mechanism of supraventricular tachycardia and localizing accessory pathways.
        Circulation. 1986; 74: 493-500
        • Weiss J.
        • Brugada P.
        • Roy D.
        • Bär F.W.
        • Wellens H.J.
        Localization of the accessory pathway in the Wolff-Parkinson-White syndrome from the ventriculo-atrial conduction time of right ventricular apical extrasystoles.
        Pacing Clin Electrophysiol. 1983; 6: 260-267
        • Benditt D.G.
        • Benson Jr., D.W.
        • Dunnigan A.
        • et al.
        Role of extrastimulus site and tachycardia cycle length in inducibility of atrial preexcitation by premature ventricular stimulation during reciprocating tachycardia.
        Am J Cardiol. 1987; 60: 811-819
        • Veenhuyzen G.D.
        • Quinn F.R.
        • Wilton S.B.
        • Clegg R.
        • Mitchell L.B.
        Diagnostic pacing maneuvers for supraventricular tachycardias: part 2.
        Pacing Clin Electrophysiol. 2012; 35: 757-769