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
Graphical Abstract
Key Words
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Article info
Publication history
Published online: June 30, 2022
Footnotes
Funding Sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Disclosures: The authors have no conflicts of interest to disclose.
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