Boonyapisit Warangkna, Methavigul Komsing, Krittayaphong Rungroj, Sriratanasathavorn Charn, Pumprueg Satchana, Suwanagool Arisara, Winijkul Arjbordin, Jongnarangsin Krit
Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Her Majesty Cardiac Center Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Pacing Clin Electrophysiol. 2016 Feb;39(2):115-21. doi: 10.1111/pace.12769. Epub 2015 Nov 19.
Postpacing interval (PPI) after right ventricular (RV) pacing entrainment minus tachycardia cycle length (TCL) with a correction for atrioventricular (AV) node delay (corrected PPI-TCL) was useful to differentiate atrioventricular node reentrant tachycardia (AVNRT) from orthodromic reciprocating tachycardia (ORT). However, the value of corrected PPI-TCL in determining the site of the accessory pathway (AP) in ORT has not been investigated. The purpose of this study was to assess whether the corrected PPI-TCL is useful in differentiating ORT using a left-sided AP from a right-sided AP.
We studied 52 patients with ORT using a left-sided AP and 13 patients with a right-sided AP. The PPI was measured upon cessation of the RV pacing at a cycle length 10-40 ms shorter than the TCL. The corrected PPI-TCL was calculated from the subtraction of the increment in AV nodal conduction time of the first PPI from the PPI-TCL.
The mean corrected PPI-TCL was 83 ± 20 ms in patients with ORT using a left-sided AP and 27 ± 19 ms in patients with a right-sided AP (P ≤ 0.001). All patients with ORT using a left-sided AP except three patients with left septal AP and none of the patients with ORT using a right-sided AP had a corrected PPI-TCL > 55 ms.
The corrected PPI-TCL after the RV pacing entrainment is useful to guide differentiating ORT using a left-sided AP from a right-sided AP.
右心室（RV）起搏拖带后的起搏后间期（PPI）减去心动过速周期长度（TCL）并校正房室（AV）结延迟（校正后的PPI-TCL），有助于区分房室结折返性心动过速（AVNRT）和顺向性折返性心动过速（ORT）。然而，校正后的PPI-TCL在确定ORT中旁路（AP）部位的价值尚未得到研究。本研究的目的是评估校正后的PPI-TCL是否有助于鉴别使用左侧AP的ORT和右侧AP的ORT。
我们研究了52例使用左侧AP的ORT患者和13例使用右侧AP的ORT患者。在RV起搏停止时，以比TCL短10-40 ms的周期长度测量PPI。校正后的PPI-TCL通过从PPI-TCL中减去第一个PPI的房室结传导时间增量来计算。
使用左侧AP的ORT患者校正后的PPI-TCL平均值为83±20 ms，使用右侧AP的ORT患者为27±19 ms（P≤0.001）。除3例左间隔AP患者外，所有使用左侧AP的ORT患者以及所有使用右侧AP的ORT患者校正后的PPI-TCL均>55 ms。
RV起搏拖带后的校正PPI-TCL有助于鉴别使用左侧AP的ORT和右侧AP的ORT。
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