TY - JOUR
T1 - Utilization of retrograde right bundle branch block to differentiate atrioventricular nodal from accessory pathway conduction
AU - Kapa, Suraj
AU - Henz, Benhur D.
AU - Dib, Chadi
AU - Cha, Yong Mei
AU - Friedman, Paul A.
AU - Munger, Thomas M.
AU - Ladewig, Dorothy J.
AU - Hammill, Stephen C.
AU - Packer, Douglas L.
AU - Asirvatham, Samuel J.
PY - 2009/7
Y1 - 2009/7
N2 - Retrograde RBBB to Define Retrograde V-A Conduction. Introduction: Defining whether retrograde ventriculoatrial (V-A) conduction is via the AV node (AVN) or an accessory pathway (AP) is important during ablation procedures for supraventricular tachycardia (SVT). With the introduction of ventricular extrastimuli (VEST), retrograde right bundle branch block (RBBB) may occur, prolonging the V-H interval, but only when AV node conduction is present. We hypothesized that when AP conduction was present, the V-A interval would increase less than the V-H interval, whereas with retrograde nodal conduction, the V-A interval would increase at least as much as the V-H interval. Methods and Results: We retrospectively reviewed the electrophysiological studies of patients undergoing ablation for AVN reentrant tachycardia (AVNRT) (55) or AVRT (50), for induction of retrograde RBBB during the introduction of VEST, and the change in the measured V-H and V-A intervals. Results were found to be reproducible between independent observers. Out of 105 patients, 84 had evidence of induced retrograde RBBB. The average V-H interval increase with induction of RBBB was 53.7 ms for patients with AVRT and 54.4 ms for patients with AVNRT (P = NS). The average V-A interval increase with induction of RBBB was 13.6 ms with AVRT and 70.1 ms with AVNRT (P < 0.001). All patients with a greater V-H than V-A interval change had AVRT, and those with a smaller had AVNRT. Conclusions: Induction of retrograde RBBB during VEST is common during an electrophysiological study for SVT. The relative change in the intervals during induction of RBBB accurately differentiates between retrograde AVN and AP conduction. (J Cardiovasc Electrophysiol, Vol. 20, pp. 751-758, July 2009)
AB - Retrograde RBBB to Define Retrograde V-A Conduction. Introduction: Defining whether retrograde ventriculoatrial (V-A) conduction is via the AV node (AVN) or an accessory pathway (AP) is important during ablation procedures for supraventricular tachycardia (SVT). With the introduction of ventricular extrastimuli (VEST), retrograde right bundle branch block (RBBB) may occur, prolonging the V-H interval, but only when AV node conduction is present. We hypothesized that when AP conduction was present, the V-A interval would increase less than the V-H interval, whereas with retrograde nodal conduction, the V-A interval would increase at least as much as the V-H interval. Methods and Results: We retrospectively reviewed the electrophysiological studies of patients undergoing ablation for AVN reentrant tachycardia (AVNRT) (55) or AVRT (50), for induction of retrograde RBBB during the introduction of VEST, and the change in the measured V-H and V-A intervals. Results were found to be reproducible between independent observers. Out of 105 patients, 84 had evidence of induced retrograde RBBB. The average V-H interval increase with induction of RBBB was 53.7 ms for patients with AVRT and 54.4 ms for patients with AVNRT (P = NS). The average V-A interval increase with induction of RBBB was 13.6 ms with AVRT and 70.1 ms with AVNRT (P < 0.001). All patients with a greater V-H than V-A interval change had AVRT, and those with a smaller had AVNRT. Conclusions: Induction of retrograde RBBB during VEST is common during an electrophysiological study for SVT. The relative change in the intervals during induction of RBBB accurately differentiates between retrograde AVN and AP conduction. (J Cardiovasc Electrophysiol, Vol. 20, pp. 751-758, July 2009)
KW - AV node reentrant tachycardia
KW - Accessory pathway
KW - Radiofrequency ablation
KW - Retrograde right bundle branch block
KW - Supraventricular tachycardia
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U2 - 10.1111/j.1540-8167.2009.01447.x
DO - 10.1111/j.1540-8167.2009.01447.x
M3 - Article
C2 - 19298561
AN - SCOPUS:67649639428
SN - 1045-3873
VL - 20
SP - 751
EP - 758
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 7
ER -