A novel approach to differentiating orthodromic reciprocating tachycardia from atrioventricular nodal reentrant tachycardia

Gopi Dandamudi, Rasoul Mokabberi, Chafik Assal, Mithilesh Das, Jess Oren, Randle Storm, Pugazhendhi Vijayaraman, John Miller

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: Various diagnostic maneuvers have been proposed to help differentiate orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentrant tachycardia (AVNRT) prior to ablation. However, not all criteria are applicable in every situation as each has limitations. Objective: The purpose of this study was to determine whether the behavior of tachycardia during onset of right ventricular (RV) pacing would help differentiate ORT from AVNRT. Methods: We retrospectively reviewed 72 cases (42 typical AVNRT, 7 atypical AVNRT, 15 left free-wall pathways, 6 septal pathways, 2 right free-wall pathways). We assessed the number of beats required to accelerate the tachycardia cycle length (TCL) to the paced cycle length (PCL) once a fully RV paced complex was achieved during supraventricular tachycardia. Results: In the AVNRT group, delta cycle length (DCL = PCL-TCL) was 29 ± 16 ms compared to 29 ± 10 ms in ORT group (P = NS). In the AVNRT group, the average number of fully RV paced beats required to reset the tachycardia was 3.7 ± 1.1 compared to 1 ± 0 in the ORT group (P <.0001). Using a cutoff >1 beat yielded both positive and negative predictive values of 100% for diagnosing AVNRT versus ORT. During entrainment attempts, AVNRT terminated 51% of the time and ORT terminated 65% of the time but still allowed application of the new criterion. Conclusion: Assessing timing and type of response of supraventricular tachycardia to RV pacing can help differentiate ORT from AVNRT with high certainty and prevent the need for other pacing maneuvers and measurements.

Original languageEnglish
Pages (from-to)1326-1329
Number of pages4
JournalHeart Rhythm
Volume7
Issue number9
DOIs
StatePublished - Sep 2010

Fingerprint

Reciprocating Tachycardia
Atrioventricular Nodal Reentry Tachycardia
Tachycardia
Supraventricular Tachycardia

Keywords

  • Atrioventricular nodal reentrant tachycardia
  • Orthodromic reciprocating tachycardia
  • Radiofrequency ablation
  • Right ventricular overdrive pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

A novel approach to differentiating orthodromic reciprocating tachycardia from atrioventricular nodal reentrant tachycardia. / Dandamudi, Gopi; Mokabberi, Rasoul; Assal, Chafik; Das, Mithilesh; Oren, Jess; Storm, Randle; Vijayaraman, Pugazhendhi; Miller, John.

In: Heart Rhythm, Vol. 7, No. 9, 09.2010, p. 1326-1329.

Research output: Contribution to journalArticle

Dandamudi, Gopi ; Mokabberi, Rasoul ; Assal, Chafik ; Das, Mithilesh ; Oren, Jess ; Storm, Randle ; Vijayaraman, Pugazhendhi ; Miller, John. / A novel approach to differentiating orthodromic reciprocating tachycardia from atrioventricular nodal reentrant tachycardia. In: Heart Rhythm. 2010 ; Vol. 7, No. 9. pp. 1326-1329.
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abstract = "Background: Various diagnostic maneuvers have been proposed to help differentiate orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentrant tachycardia (AVNRT) prior to ablation. However, not all criteria are applicable in every situation as each has limitations. Objective: The purpose of this study was to determine whether the behavior of tachycardia during onset of right ventricular (RV) pacing would help differentiate ORT from AVNRT. Methods: We retrospectively reviewed 72 cases (42 typical AVNRT, 7 atypical AVNRT, 15 left free-wall pathways, 6 septal pathways, 2 right free-wall pathways). We assessed the number of beats required to accelerate the tachycardia cycle length (TCL) to the paced cycle length (PCL) once a fully RV paced complex was achieved during supraventricular tachycardia. Results: In the AVNRT group, delta cycle length (DCL = PCL-TCL) was 29 ± 16 ms compared to 29 ± 10 ms in ORT group (P = NS). In the AVNRT group, the average number of fully RV paced beats required to reset the tachycardia was 3.7 ± 1.1 compared to 1 ± 0 in the ORT group (P <.0001). Using a cutoff >1 beat yielded both positive and negative predictive values of 100{\%} for diagnosing AVNRT versus ORT. During entrainment attempts, AVNRT terminated 51{\%} of the time and ORT terminated 65{\%} of the time but still allowed application of the new criterion. Conclusion: Assessing timing and type of response of supraventricular tachycardia to RV pacing can help differentiate ORT from AVNRT with high certainty and prevent the need for other pacing maneuvers and measurements.",
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AU - Dandamudi, Gopi

AU - Mokabberi, Rasoul

AU - Assal, Chafik

AU - Das, Mithilesh

AU - Oren, Jess

AU - Storm, Randle

AU - Vijayaraman, Pugazhendhi

AU - Miller, John

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N2 - Background: Various diagnostic maneuvers have been proposed to help differentiate orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentrant tachycardia (AVNRT) prior to ablation. However, not all criteria are applicable in every situation as each has limitations. Objective: The purpose of this study was to determine whether the behavior of tachycardia during onset of right ventricular (RV) pacing would help differentiate ORT from AVNRT. Methods: We retrospectively reviewed 72 cases (42 typical AVNRT, 7 atypical AVNRT, 15 left free-wall pathways, 6 septal pathways, 2 right free-wall pathways). We assessed the number of beats required to accelerate the tachycardia cycle length (TCL) to the paced cycle length (PCL) once a fully RV paced complex was achieved during supraventricular tachycardia. Results: In the AVNRT group, delta cycle length (DCL = PCL-TCL) was 29 ± 16 ms compared to 29 ± 10 ms in ORT group (P = NS). In the AVNRT group, the average number of fully RV paced beats required to reset the tachycardia was 3.7 ± 1.1 compared to 1 ± 0 in the ORT group (P <.0001). Using a cutoff >1 beat yielded both positive and negative predictive values of 100% for diagnosing AVNRT versus ORT. During entrainment attempts, AVNRT terminated 51% of the time and ORT terminated 65% of the time but still allowed application of the new criterion. Conclusion: Assessing timing and type of response of supraventricular tachycardia to RV pacing can help differentiate ORT from AVNRT with high certainty and prevent the need for other pacing maneuvers and measurements.

AB - Background: Various diagnostic maneuvers have been proposed to help differentiate orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentrant tachycardia (AVNRT) prior to ablation. However, not all criteria are applicable in every situation as each has limitations. Objective: The purpose of this study was to determine whether the behavior of tachycardia during onset of right ventricular (RV) pacing would help differentiate ORT from AVNRT. Methods: We retrospectively reviewed 72 cases (42 typical AVNRT, 7 atypical AVNRT, 15 left free-wall pathways, 6 septal pathways, 2 right free-wall pathways). We assessed the number of beats required to accelerate the tachycardia cycle length (TCL) to the paced cycle length (PCL) once a fully RV paced complex was achieved during supraventricular tachycardia. Results: In the AVNRT group, delta cycle length (DCL = PCL-TCL) was 29 ± 16 ms compared to 29 ± 10 ms in ORT group (P = NS). In the AVNRT group, the average number of fully RV paced beats required to reset the tachycardia was 3.7 ± 1.1 compared to 1 ± 0 in the ORT group (P <.0001). Using a cutoff >1 beat yielded both positive and negative predictive values of 100% for diagnosing AVNRT versus ORT. During entrainment attempts, AVNRT terminated 51% of the time and ORT terminated 65% of the time but still allowed application of the new criterion. Conclusion: Assessing timing and type of response of supraventricular tachycardia to RV pacing can help differentiate ORT from AVNRT with high certainty and prevent the need for other pacing maneuvers and measurements.

KW - Atrioventricular nodal reentrant tachycardia

KW - Orthodromic reciprocating tachycardia

KW - Radiofrequency ablation

KW - Right ventricular overdrive pacing

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