心动过速诱发时VA间期的变异性：一种区分顺向性折返性心动过速与非典型房室结折返性心动过速的简单方法。
Variability of the VA interval at tachycardia induction: a simple method to differentiate orthodromic reciprocating tachycardia from atypical atrioventricular nodal reentrant tachycardia.
作者信息
Hadid Claudio, Celano Leonardo, Di Toro Darío, Antezana-Chavez Edgar, Gallino Sebastián, Iralde Gustavo, Calvo David, Ávila Pablo, Atea Leonardo, Gonzalez Sergio, Maldonado Sebastián, Labadet Carlos
机构信息
Hospital General de Agudos Dr. Cosme Argerich, Pi y Margall 750, 1155, Ciudad Autónoma de Buenos Aires, Argentina.
Hospital Universitario CEMIC, Ciudad Autónoma de Buenos Aires, Argentina.
出版信息
J Interv Card Electrophysiol. 2023 Apr;66(3):637-645. doi: 10.1007/s10840-022-01376-w. Epub 2022 Sep 24.
BACKGROUND
The differential diagnosis between orthodromic atrioventricular reentry tachycardia (AVRT) and atypical AV nodal reentrant tachycardia (aAVNRT) is sometimes challenging. We hypothesize that aAVNRTs have more variability in the retrograde conduction time at tachycardia onset than AVRTs.
METHODS
We aimed to assess the variability in retrograde conduction time at tachycardia onset in AVRT and aAVNRT and to propose a new diagnostic tool to differentiate these two arrhythmia mechanisms. We measured the VA interval of the first beats after tachycardia induction until it stabilized. The difference between the maximum and minimum VA intervals (∆VA) and the number of beats needed for the VA interval to stabilize was analyzed. Atrial tachycardias were excluded.
RESULTS
A total of 107 patients with aAVNRT (n = 37) or AVRT (n = 64) were included. Six additional patients with decremental accessory pathway-mediated tachycardia (DAPT) were analyzed separately. All aAVNRTs had VA interval variability. The median ∆VA was 0 (0 - 5) ms in AVRTs vs 40 (21 - 55) ms in aAVNRTs (p < 0.001). The VA interval stabilized significantly earlier in AVRTs (median 1.5 [1 - 3] beats) than in aAVNRTs (5 [4 - 7] beats; p < 0.001). A ∆VA < 10 ms accurately differentiated AVRT from aAVNRT with 100% of sensitivity, specificity, and positive and negative predictive values. The stabilization of the VA interval at < 3 beats of the tachycardia onset identified AVRT with sensitivity, specificity, and positive and negative predictive values of 64.1%, 94.6%, 95.3%, and 60.3%, respectively. A ∆VA < 20 ms yielded good diagnostic accuracy for DAPT.
CONCLUSIONS
A ∆VA < 10 ms is a simple and useful criterion that accurately distinguished AVRT from atypical AVNRT. Central panel: Scatter plot showing individual values of ∆VA in atypical AVNRT and AVRT. Left panel: induction of atypical AVNRT. The VA interval stabilizes at the 5th beat and the ∆VA is 62 ms (maximum VA interval: 172 ms - minimum VA interval: 110 ms). Right panel: induction of AVRT. The tachycardia has a fixed VA interval from the first beat. ∆VA is 0 ms.
背景
顺向型房室折返性心动过速（AVRT）与非典型房室结折返性心动过速（aAVNRT）的鉴别诊断有时具有挑战性。我们假设，与AVRT相比，aAVNRT在心动过速发作时的逆向传导时间变异性更大。
方法
我们旨在评估AVRT和aAVNRT心动过速发作时逆向传导时间的变异性，并提出一种新的诊断工具来区分这两种心律失常机制。我们测量了心动过速诱发后直至稳定的首个心搏的VA间期。分析了最大和最小VA间期之差（∆VA）以及VA间期稳定所需的心搏数。排除房性心动过速。
结果
共纳入107例aAVNRT患者（n = 37）或AVRT患者（n = 64）。另外6例递减型旁路介导性心动过速（DAPT）患者单独进行分析。所有aAVNRT均存在VA间期变异性。AVRT的∆VA中位数为0（0 - 5）ms，而aAVNRT为40（21 - 55）ms（p < 0.001）。AVRT的VA间期显著更早稳定（中位数1.5 [1 - 3]个心搏），而aAVNRT为5（4 - 7）个心搏（p < 0.001）。∆VA < 10 ms能准确区分AVRT与aAVNRT，敏感性、特异性、阳性预测值和阴性预测值均为100%。心动过速发作< 3个心搏时VA间期稳定可识别AVRT，敏感性、特异性、阳性预测值和阴性预测值分别为64.1%、94.6%、95.3%和60.3%。∆VA < 20 ms对DAPT具有良好的诊断准确性。
结论
∆VA < 10 ms是一种简单且有用的标准，能准确区分AVRT与非典型AVNRT。中间图：散点图显示非典型AVNRT和AVRT中∆VA的个体值。左图：非典型AVNRT的诱发。VA间期在第5个心搏时稳定，∆VA为62 ms（最大VA间期：共纳入107例aAVNRT患者（n = 37）或AVRT患者（n = 64）。另外6例递减型旁路介导性心动过速（DAPT）患者单独进行分析。所有aAVNRT均存在VA间期变异性。AVRT的∆VA中位数为0（0 - 5）ms，而aAVNRT为40（21 - 55）ms（p < 0.001）。AVRT的VA间期显著更早稳定（中位数1.5 [1 - 3]个心搏），而aAVNRT为5（4 - 7）个心搏（p < 0.001）。∆VA < 10 ms能准确区分AVRT与aAVNRT，敏感性、特异性、阳性预测值和阴性预测值均为为172 ms - 最小VA间期：110 ms）。右图：AVRT的诱发。心动过速从首个心搏起具有固定的VA间期。∆VA为0 ms。
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