Negative SA-VA difference during ventricular overdrive pacing of supraventricular tachycardia for the diagnosis of atrial tachycardia
Introduction and objectives: The stimulus-atrial minus ventriculo-atrial interval (SA-VA) difference during ventricular overdrive pacing of a supraventricular tachycardia is used to differentiate atrioventricular reciprocating tachycardia (AVRT) from atrioventricular nodal re-entrant tachycardia (AV...
| Autores: | , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Universitat Pompeu Fabra |
| Repositorio: | Repositorio Digital de la UPF |
| OAI Identifier: | oai:dnet:rdupf_______::2fe30b3ebe8c7a85fadd2353a0e12f33 |
| Acceso en línea: | https://hdl.handle.net/10230/73042 http://dx.doi.org/10.1016/j.rec.2025.03.005 |
| Access Level: | acceso abierto |
| Palabra clave: | Atrial tachycardia Cardiac electrophysiologic study Entrainment maneuvers Supraventricular tachycardia |
| Sumario: | Introduction and objectives: The stimulus-atrial minus ventriculo-atrial interval (SA-VA) difference during ventricular overdrive pacing of a supraventricular tachycardia is used to differentiate atrioventricular reciprocating tachycardia (AVRT) from atrioventricular nodal re-entrant tachycardia (AVNRT), but positive values have always been reported. In atrial tachycardia, the SA conduction is unrelated to the tachycardia mechanism, allowing for negative SA-VA values. We postulated that a negative SA-VA may serve as a criterion for atrial tachycardia in patients with supraventricular tachycardia and ventricular overdrive pacing from the right ventricular apex. Methods: Multicenter data from ventricular overdrive pacing during atrial tachycardia (from 6 centers) and during AVRT and AVNRT (from 2 centers) were retrospectively and consecutively collected. The correct diagnosis was established using conventional criteria. The SA-VA difference was calculated for each case. The optimal SA-VA cut-off point for the diagnosis of atrial tachycardia was determined. Results: Out of 240 tachycardias analyzed, ventricular overdrive pacing succeeded in accelerating the atria to the pacing rate without tachycardia termination in 106 cases: 38 (36%) AVNRT, 33 (31%) AVRT, and 35 (33%) atrial tachycardias (all exhibiting long VA intervals). All atrial tachycardias had a negative SA-VA value, while all AVNRT and AVRT cases had positive SA-VA values. A SA-VA value lower than 0ms was the best cutoff, with an area under the curve of 1 and 100% sensitivity and specificity for the diagnosis of atrial tachycardia. Conclusions: A negative SA-VA difference is a novel and accurate criterion for the diagnosis of atrial tachycardia with long VA intervals. |
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