A SIMPLE CRITERION OF 'V-H-A PATTERN BY VENTRICULAR EXTRASTIMULUS' FOR THE DIAGNOSIS OF ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA

摘要

Differentiation of atrioventricular nodal reentrant tachycardia (AVNRT) from AV reciprocating tachycardia (AVRT) is difficult in some patients, especially in those with atypical AVNRT. AVNRT is diagnosed by the presence of dual AV nodal pathways (criterion DP) and the earliest atrial activation at His bundle region during tachycardia (criterion EAA). During ventricular extrastimulation done during sinus rhythm, obvious retrograde His activation (H) following ventricular activation (V) and followed by atrial activation (A) is observed (V-H-A pattern) when retrograde ventriculo-atrial conduction occurs only via the normal AV conduction system. We retrospectively analyzed the criteria for AVNRT in 158 patients with paroxysmal supraventricular tachycardia (92 with AVNRT and 66 with AVRT). Criterion DP was demonstrated in 75/92 in AVNRT and in 7/66 in AVRT. Criterion EAA was demonstrated in 72/92 in AVNRT and in 2/66 in AVRT. V-H-A pattern was demonstrated in 87 of 92 in AVNRT and in 2/66 in AVRT. The sensitivity and specificity was 81 % and 85% in Criterion DP, 78% and 97% in Criterion EAA, 94% and 97% in V-H-A pattern, respectively. Thus, V-H-A pattern by ventricular extrastimulus during sinus rhythm is a simple, reliable criterion for the diagnosis of AVNRT in comparison with other criterions.