Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ibaraki, Tokyo, Japan.
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
JACC Clin Electrophysiol. 2020 Dec;6(14):1797-1807. doi: 10.1016/j.jacep.2020.07.007. Epub 2020 Sep 30.
This study sought to assess the performance of current diagnostic criteria and identify additional electrophysiological features differentiating orthodromic reciprocating tachycardia (ORT) with a concealed nodoventricular/nodofascicular (NV/NF) pathway from atrioventricular nodal re-entrant tachycardia (AVNRT).
Diagnosing sustained supraventricular tachycardia (SVT) despite the occurrence of ventriculoatrial block (VAB) is challenging.
We analyzed electrograms of 25 sustained SVTs (9 NV/NF-ORTs [n = 7/2] and 16 AVNRTs) with VAB and 91 AVNRTs without VAB (for reference).
More than 1 SVT, each with a different ventriculoatrial interval, was commonly induced in AVNRT cases (75%) but not in NV/NF-ORT cases (0%; p = 0.0005). Wenckebach VAB was common in NV/NF-ORTs (78%), but VAB patterns varied in AVNRTs. The His-His interval transiently prolonged in the following beat after the VAB in most AVNRTs but rarely did in NV/NF-ORTs (79% vs. 22%; p = 0.01). NV/NF-ORT was diagnosed by His-refractory premature ventricular contractions (n = 5) and the findings during right ventricular overdrive pacing showing an uncorrected/corrected post-pacing interval (PPI)-tachycardia cycle length (TCL) ≤115/110 ms (n = 5/5), orthodromic His capture (n = 6), and V-V-A (ventricle-ventricle-atrial response) response (n = 3). A single form of induced SVT (positive predictive value [PPV]: 69%; negative predictive value [NPV]: 100%), Wenckebach VAB (PPV: 70%; NPV: 87%), stable His-His interval despite VAB (PPV: 70%; NPV: 85%), orthodromic His capture (PPV: 100%; NPV: 97%), and V-V-A response (PPV: 100%; NPV: 95%) characterized NV/NF-ORT, and a PPI-TCL of ≤125 ms (PPV: 100%; NPV: 100%) characterized NV-ORT.
Induction of a single SVT form, Wenckebach VAB, stable His-His interval despite VAB, orthodromic His capture, and V-V-A response appeared to discriminate NV/NF-ORT from AVNRT, with a PPI-TCL of ≤125 ms discriminating NV-ORT from NF-ORT and AVNRT.
本研究旨在评估当前诊断标准的性能，并确定鉴别显性折返性心动过速（ORT）伴隐匿性房室结/房室结下（NV/NF）径路与房室结折返性心动过速（AVNRT）的其他电生理特征。
尽管存在室房阻滞（VAB），诊断持续性室上性心动过速（SVT）仍然具有挑战性。
我们分析了 25 例伴有 VAB 的持续性 SVT（9 例 NV/NF-ORT [n=7/2]和 16 例 AVNRT）和 91 例无 VAB 的 AVNRT（作为参考）的心电图。
在 AVNRT 病例中（75%），通常可以诱发多种不同的 SVT，每种 SVT 都有不同的室房间期，但在 NV/NF-ORT 病例中（0%；p=0.0005）则不然。Wenckebach 型 VAB 在 NV/NF-ORT 中很常见（78%），但在 AVNRT 中 VAB 模式各不相同。在大多数 AVNRT 中，在 VAB 之后的下一个心搏中 His-His 间期会短暂延长，但在 NV/NF-ORT 中很少见（79%对 22%；p=0.01）。通过希氏束不应期期前收缩（n=5）和右心室超速起搏时的发现来诊断 NV/NF-ORT，表现为未矫正/矫正后起搏间期（PPI）-心动过速周期长度（TCL）≤115/110 ms（n=5/5）、顺向希氏束捕获（n=6）和 V-V-A（心室-心室-心房反应）反应（n=3）。单一形式的诱发 SVT（阳性预测值[PPV]：69%；阴性预测值[NPV]：100%）、Wenckebach VAB（PPV：70%；NPV：87%）、尽管存在 VAB 但 His-His 间期稳定（PPV：70%；NPV：85%）、顺向希氏束捕获（PPV：100%；NPV：97%）和 V-V-A 反应（PPV：100%；NPV：95%）可鉴别 NV/NF-ORT，PPI-TCL≤125 ms（PPV：100%；NPV：100%）可鉴别 NV-ORT。
单一 SVT 形式的诱发、Wenckebach VAB、尽管存在 VAB 但 His-His 间期稳定、顺向希氏束捕获和 V-V-A 反应似乎可以鉴别 NV/NF-ORT 与 AVNRT，而 PPI-TCL≤125 ms 可鉴别 NV-ORT 与 NF-ORT 和 AVNRT。
