Bouyer Benjamin, Derval Nicolas, Pambrun Thomas, Tixier Romain, Arnaud Marine, Buliard Samuel, Chauvel Rémi, Marchand Hugo, Bouteiller Xavier, Vlachos Konstantinos, Ascione Ciro, Yokoyama Masaaki, Kowalewski Christopher, Hocini Mélèze, Jaïs Pierre, Sacher Frederic, Haïssaguerre Michel, Duchateau Josselin
Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France.
Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France.
Heart Rhythm. 2024 Jun;21(6):828-835. doi: 10.1016/j.hrthm.2024.01.042. Epub 2024 Jan 27.
Differentiating between atypical atrioventricular nodal reentrant tachycardia (AVNRT) and orthodromic reciprocating tachycardia utilizing a septal accessory pathway is a complex challenge.
The purpose of this study was to describe the "local VA index," a straightforward method based on signals from the coronary sinus catheter, to distinguish between these arrhythmias during tachycardia and entrainment. The ventriculoatrial (VA) interval on the coronary sinus catheter is measured during tachycardia and entrainment, at the site of earliest atrial activity. The difference between these 2 situations defines the "local VA index." We also propose a mechanism to clarify the limitations of historical pacing maneuvers, such as postpacing interval minus tachycardia cycle length (PPI-TCL) and stimulus-atrial interval minus ventriculoatrial interval (SA-VA), by examining nodal decrement and intraventricular conduction delay.
In a retrospective study of 75 patients referred for supraventricular tachycardia evaluation, 37 were diagnosed with atrioventricular reentrant tachycardia (AVRT) with orthodromic reciprocating tachycardia, and 38 with AVNRT (27 typical, 11 atypical).
In comparison to AVRT patients, AVNRT patients exhibited longer PPI-TCL (176 ± 47 ms vs 113 ± 42 ms; P <.01) and SA-VA (138 ± 47 ms vs 64 ± 28 ms; P <.01). The AVRT group had mean local VA index of -1 ± 13 ms, whereas the AVNRT group had a significantly longer index of 91 ± 46 ms (P <.01). An optimal threshold for differentiation was a local VA index of 40 ms. Importantly, there was no significant correlation between pacing cycle length and nodal decrement as well as intraventricular delay related to pathway location. This interindividual variability might explain misleading interpretations of PPI-TCL and SA-VA.
This novel approach is advantageous because of its simplicity and effectiveness, requiring only 2 diagnostic catheters. A local VA interval difference <40 ms provides a clear distinction for AVRT.
鉴别不典型房室结折返性心动过速（AVNRT）和利用间隔旁道的顺向型房室折返性心动过速是一项复杂的挑战。
本研究的目的是描述“局部VA指数”，这是一种基于冠状窦导管信号的简单方法，用于在心动过速和拖带期间区分这些心律失常。在心动过速和拖带期间，于最早心房激动部位测量冠状窦导管上的室房（VA）间期。这两种情况之间的差异定义为“局部VA指数”。我们还提出了一种机制，通过检查结递减和与旁道位置相关的室内传导延迟，来阐明历史起搏操作（如起搏后间期减去心动过速周期长度[PPI-TCL]和刺激-心房间期减去室房间期[SA-VA]）的局限性。
在一项对75例因室上性心动过速评估而转诊患者的回顾性研究中，37例被诊断为顺向型房室折返性心动过速（AVRT），38例被诊断为AVNRT（27例典型，11例不典型）。
与AVRT患者相比，AVNRT患者表现出更长的PPI-TCL（176±47毫秒对113±42毫秒；P<.01）和SA-VA（138±47毫秒对64±28毫秒；P<.01）。AVRT组的平均局部VA指数为-1±13毫秒，而AVNRT组的指数明显更长，为91±46毫秒（P<.01）。区分的最佳阈值是局部VA指数为40毫秒。重要的是，起搏周期长度与结递减以及与旁道位置相关的室内延迟之间没有显著相关性。这种个体间的变异性可能解释了对PPI-TCL和SA-VA的误导性解释。
这种新方法因其简单性和有效性而具有优势，仅需两根诊断导管。局部VA间期差异<40毫秒可为AVRT提供明确区分。
