Sarkozy Andrea, Richter Sergio, Chierchia Gian-Battista, De Asmundis Carlo, Seferlis Christos, Brugada Pedro, Kaufman Leonard, Buyl Ronald, Dorian Paul, Mangat Iqwal
Heart Rhythm Management Center, Cardiovascular Center, UZ Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels 1090, Belgium.
Europace. 2008 Apr;10(4):459-66. doi: 10.1093/europace/eun032. Epub 2008 Feb 25.
Currently used diagnostic manoeuvres at the electrophysiology study do not always allow for consistent identification of atrial tachycardia (AT), either because of inapplicability of the technique or because of low predictive value and specificity. The aim of this study was to determine whether overdrive atrial pacing during paroxysmal supraventricular tachycardia (SVT) with the same cycle length from both the high right atrium and the coronary sinus can accurately identify or exclude AT by examining the difference between the V-A intervals of the first returning beat of tachycardia between the two pacing sites.
Fifty-two patients were included; 24 patients with atrioventricular nodal re-entry tachycardia (AVNRT), 13 patients with atrioventricular re-entry tachycardia (AVRT), and 15 patients with AT. Comparing the 37 non-AT patients with the 15 AT patients, there was a highly significant difference between the mean V-A interval difference, (delta V-A) 2.1 +/- 1.8 ms (range 0-9 ms) vs. 79.1 +/- 42 (range 22-267 ms) (P < 0.001), respectively. None of the patients in the non-AT group had a delta V-A > 10 ms. In contrast, all 15 patients with AT had a delta V-A interval >10 ms. Thus, the diagnostic accuracy of the delta V-A interval cut-off of >10 ms was 100%, with a 95% confidence interval of 93.1-100% for AT. In 11 (73%) of the 15 AT patients, the standard ventricular overdrive pacing manoeuvre was not possible. In 14 of the 15 patients (93%) in the AT group, standard atrial overdrive pacing showed variable V-A intervals, correctly diagnosing AT. In all 52 patients, this measurement was repeated during pacing from the other location. In five patients from the AT group, the result of the second attempt was different from the result of the first attempt.
We found that atrial differential pacing during paroxysmal SVT without termination of tachycardia and the finding of variable returning V-A interval was highly sensitive and specific for the diagnosis of AT. The manoeuvre can be easily performed in all patients with SVT and is highly reproducible. It is a useful adjunct to the currently available ventricular and atrial pacing manoeuvres.
目前在电生理研究中使用的诊断操作并不总是能够一致地识别房性心动过速（AT），这要么是因为该技术不适用，要么是因为预测价值和特异性较低。本研究的目的是确定在阵发性室上性心动过速（SVT）期间，从高位右心房和冠状窦以相同周期长度进行超速心房起搏，通过检查两个起搏部位心动过速首次折返搏动的V-A间期差异，是否能够准确识别或排除AT。
纳入52例患者；24例房室结折返性心动过速（AVNRT）患者、13例房室折返性心动过速（AVRT）患者和15例AT患者。将37例非AT患者与15例AT患者进行比较，平均V-A间期差值（ΔV-A）分别为2.1±1.8毫秒（范围0-9毫秒）与79.1±42（范围22-267毫秒），差异具有高度显著性（P<0.001）。非AT组患者中无一例ΔV-A>10毫秒。相比之下，15例AT患者的ΔV-A间期均>10毫秒。因此，ΔV-A间期截断值>10毫秒的诊断准确性为100%，AT的95%置信区间为93.1-100%。15例AT患者中有11例（73%）无法进行标准的心室超速起搏操作。AT组15例患者中有14例（93%），标准心房超速起搏显示V-A间期可变，正确诊断为AT。在所有52例患者中，从另一个部位起搏时重复了该测量。AT组中有5例患者第二次尝试的结果与第一次尝试的结果不同。
我们发现，在阵发性SVT期间进行心房差异起搏且不终止心动过速，以及发现折返V-A间期可变，对AT的诊断具有高度敏感性和特异性。该操作可在所有SVT患者中轻松进行，且具有高度可重复性。它是目前可用的心室和心房起搏操作的有用辅助手段。
