Title
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Prospective evaluation of the length of the lower common pathway in the differential diagnosis of various forms of AV nodal reentrant tachycardia
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Author
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Abstract
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The conduction time over the lower common pathway (LCP) in AVNRT can be assessed by subtracting the HA-interval during tachycardia (HA(t)) from that during ventricular pacing at exactly the same cycle length (HA(p)) (Delta HA = HA(p)-HA(t)). It has been suggested that H-A measurements may help in the differentiation, of Slow/Fast from Slow/Slow AVNRT. This study evaluated prospectively in 61 consecutive patients with AVNRT (43 +/- 15 y; 46 women, all with antegrade conduction during AVNRT over the slow pathway) how often a reliable measurement of the length of the LCP could be made, and in how far the results were concordant with mapping criteria for the differentiation of Slow/Fast from Slow:;Slow AVNRT. A new para-Hisian pacing technique (using only the His bundle catheter) was applied in all patients. Comparison of HA(t) and HA(p) was possible in 44 of the 61 patients (72%). In these 44 patients HA(p), was longer than HA(t) in 12 patients, indicating the presence of a LCP. All patients with Delta HA greater than or equal to 15 ms had earliest retrograde atrial activation in the posterior septum (Slow/Slow AVNRT; n = 6) or simultaneously in the anterior and posterior septum (n = I). On the other hand, 31 of the 32 patients without evidence of a substantial LCP (Delta HA less than or equal to 0) had typical Slow/Fast AVNRT. Moreover, although it appears logical for Slow/Fast AVNRT to have a shorter HA(t) than Slow/Slow AVNRT, an HA(p) of greater than or equal to 70 ms was a better discriminator between the two forms of AVNRT than any HA(t) value. Therefore, Delta HA greater than or equal to 15 ms !(sens. greater than or equal to 86%; spec. greater than or equal to 97%) or HA(p) greater than or equal to 70 ms(sens. = 100%; spec. 89%) were,, highly indicative for the Slow/Slow variant of AVNRT. Using a para-Hisian pacing technique, H-A measurements can be performed in 72% of AVNRT patients?. They can be used as an important tool in the differentiation of Slow/Fast and Slow/Slow AVNRT. |
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Language
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English
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Source (journal)
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Pacing and clinical electrophysiology. - Mount Kisco, N.Y., 1978, currens
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Publication
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Mount Kisco, N.Y.
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1998
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ISSN
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0147-8389
[print]
1540-8159
[online]
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DOI
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10.1111/J.1540-8159.1998.TB01090.X
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Volume/pages
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21
:12
(1998)
, p. 209-216
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ISI
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000071628900015
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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