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Europace Advance Access originally published online on September 5, 2008
Europace 2008 10(10):1205-1211; doi:10.1093/europace/eun249
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

CLINICAL RESEARCH

Entrainment from the para-Hisian region for differentiating atrioventricular node reentrant tachycardia from orthodromic atrioventricular reentrant tachycardia

Jordi Pérez-Rodon1, Victor Bazan1,*, Jordi Bruguera-Cortada1, Sergi Mojal-García2, Josep M. Manresa-Domínguez2 and Julio Martí-Almor1

1 Electrophysiology Unit, Cardiology Department, Hospital del Mar, IMAS, 25 Passeig Marítim, 08003 Barcelona, Spain; 2 Parc de Recerca Biomèdica, 88 Doctor Aiguader, 08003 Barcelona, Spain

Aims: The difference between the stimulus-atrial and ventriculo-atrial intervals (SA–VA) and between the post-pacing interval and the tachycardia cycle length (PPI–TCL) during entrainment from the right ventricular apex distinguishes atrioventricular node reentrant (AVNRT) from orthodromic atrioventricular reentrant tachycardia (AVRT). We hypothesized that these features still apply when entrainment is performed from the para-Hisian region.

Methods and results: Forty-seven supraventricular tachycardias (34 AVNRT/13 AVRT) were included. The SA–VA and PPI–TCL were obtained in all patients by using two right-sided diagnostic catheters. In 24 of them, these measurements were also performed upon His-bundle capture during entrainment. A paced QRS widening of ≥40 ms during entrainment, when compared with the tachycardia QRS width, identified absence of His-bundle capture, P < 0.001. A SA–VA >75 ms distinguished AVNRT from AVRT, P < 0.001 (sensitivity/specificity 97%/100%). A PPI–TCL >100 ms was diagnostic of AVNRT, P < 0.001 (sensitivity/specificity 97%/92%). Upon His-bundle capture, the SA–VA and PPI–TCL shortened in AVNRT (121 ± 23 to 66 ± 24 ms; 139 ± 30 to 85 ± 31 ms, respectively, P < 0.001) and no longer differentiated AVNRT from AVRT.

Conclusion: Para-Hisian entrainment without His-bundle capture distinguishes AVNRT from AVRT with the advantage of using only two diagnostic catheters.

Key Words: Entrainment, His bundle, Atrioventricular node reentrant tachycardia, Orthodromic atrioventricular reentrant tachycardia, Accessory pathway

* Corresponding author. Tel: +34 93248 34 89; fax: +34 93 248 34 89. E-mail address: vbazan{at}imas.imim.es

Manuscript submitted 24 May 2008. Accepted after revision 14 August 2008.


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