Utilization of retrograde right bundle branch block to differentiate atrioventricular nodal from accessory pathway conduction

Suraj Kapa, Benhur D. Henz, Chadi Dib, Yong-Mei Cha, Paul Andrew Friedman, Thomas M. Munger, Dorothy J. Ladewig, Stephen C. Hammill, Douglas L Packer, Samuel J Asirvatham

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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)

Original languageEnglish (US)
Pages (from-to)751-758
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number7
DOIs
StatePublished - Jul 2009

Fingerprint

Accessory Atrioventricular Bundle
Bundle-Branch Block
Atrioventricular Node
Tachycardia
Supraventricular Tachycardia

Keywords

  • Accessory pathway
  • AV node reentrant tachycardia
  • Radiofrequency ablation
  • Retrograde right bundle branch block
  • Supraventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Utilization of retrograde right bundle branch block to differentiate atrioventricular nodal from accessory pathway conduction. / Kapa, Suraj; Henz, Benhur D.; Dib, Chadi; Cha, Yong-Mei; Friedman, Paul Andrew; Munger, Thomas M.; Ladewig, Dorothy J.; Hammill, Stephen C.; Packer, Douglas L; Asirvatham, Samuel J.

In: Journal of Cardiovascular Electrophysiology, Vol. 20, No. 7, 07.2009, p. 751-758.

Research output: Contribution to journalArticle

@article{0d83874f9c4643de8c1cd80299ea62f6,
title = "Utilization of retrograde right bundle branch block to differentiate atrioventricular nodal from accessory pathway conduction",
abstract = "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)",
keywords = "Accessory pathway, AV node reentrant tachycardia, Radiofrequency ablation, Retrograde right bundle branch block, Supraventricular tachycardia",
author = "Suraj Kapa and Henz, {Benhur D.} and Chadi Dib and Yong-Mei Cha and Friedman, {Paul Andrew} and Munger, {Thomas M.} and Ladewig, {Dorothy J.} and Hammill, {Stephen C.} and Packer, {Douglas L} and Asirvatham, {Samuel J}",
year = "2009",
month = "7",
doi = "10.1111/j.1540-8167.2009.01447.x",
language = "English (US)",
volume = "20",
pages = "751--758",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",
number = "7",

}

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 Andrew

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 - Accessory pathway

KW - AV node reentrant tachycardia

KW - Radiofrequency ablation

KW - Retrograde right bundle branch block

KW - Supraventricular tachycardia

UR - http://www.scopus.com/inward/record.url?scp=67649639428&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67649639428&partnerID=8YFLogxK

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

VL - 20

SP - 751

EP - 758

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

IS - 7

ER -