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ICD discrimination of SVT versus VT with 1:1 V-A conduction: A review of the literature.

Cardoso RN, Healy C, Viles-Gonzalez J, Coffey JO - Indian Pacing Electrophysiol J (2016)

Bottom Line: They also impair patients' quality of life, increase hospitalizations, and raise health-care costs.V-A time, electrogram morphology, and response to antitachycardia pacing suggested atrioventricular nodal reentry tachycardia, which was confirmed in an electrophysiology study.Inspired by this case, we performed a literature review to discuss mechanisms for discrimination of supraventricular tachycardia with 1:1 A:V relationship from ventricular tachycardia with 1:1 retrograde conduction.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Division, Department of Medicine, University of Miami, Miller School of Medicine, Miami, USA.

ABSTRACT
Inappropriate ICD shocks are associated with increased mortality. They also impair patients' quality of life, increase hospitalizations, and raise health-care costs. Nearly 80% of inappropriate ICD shocks are caused by supraventricular tachycardia. Here we report the case of a patient who received a single-lead dual-chamber sensing ICD for primary prevention of sudden cardiac death and experienced inappropriate ICD shocks. V-A time, electrogram morphology, and response to antitachycardia pacing suggested atrioventricular nodal reentry tachycardia, which was confirmed in an electrophysiology study. Inspired by this case, we performed a literature review to discuss mechanisms for discrimination of supraventricular tachycardia with 1:1 A:V relationship from ventricular tachycardia with 1:1 retrograde conduction.

No MeSH data available.


Related in: MedlinePlus

The above narrow complex tachycardia was reproducibly induced following an AH jump during an EP study. The characteristics of the tachycardia included a 1:1 V-A relationship, a negative V-A time, concentric atrial activation, and entrainment intervals consistent with typical AVNRT, thereby confirming the suspected diagnosis. Following slow pathway modification the tachycardia was no longer inducible. I, II, aVF, and V1 = surface electrograms; HRA p = high right atrial intracardiac electrogram; HBEP, HBEM, and HBED = His intracardiac electrograms (proximal, mid, and distal); CS 9–10, CS 7–8, CS 5–6, CS 3–4, and CS 1–2 = coronary sinus intracardiac electrograms (proximal to distal); RVAp = right ventricular apical intracardiac electrogram.
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fig4: The above narrow complex tachycardia was reproducibly induced following an AH jump during an EP study. The characteristics of the tachycardia included a 1:1 V-A relationship, a negative V-A time, concentric atrial activation, and entrainment intervals consistent with typical AVNRT, thereby confirming the suspected diagnosis. Following slow pathway modification the tachycardia was no longer inducible. I, II, aVF, and V1 = surface electrograms; HRA p = high right atrial intracardiac electrogram; HBEP, HBEM, and HBED = His intracardiac electrograms (proximal, mid, and distal); CS 9–10, CS 7–8, CS 5–6, CS 3–4, and CS 1–2 = coronary sinus intracardiac electrograms (proximal to distal); RVAp = right ventricular apical intracardiac electrogram.

Mentions: A diagnosis of AVNRT was strongly suspected on the retrospective review of the tachycardia episode, based on the short V-A time, the unchanged ventricular morphology on intracardiac electrograms, and the response to ATP. The patient was, therefore, scheduled for an electrophysiology (EP) study and possible radiofrequency catheter ablation. Meanwhile, in order to avoid further inappropriate shocks while awaiting the EP study, the VF zone was increased to greater than 233 bpm. At the EP study, dual AV nodal physiology was in fact revealed. A narrow complex tachycardia was reproducibly induced with single atrial extra-stimuli (Fig. 4). The tachycardia had a 1:1 VA relationship, a negative V-A time, and concentric atrial activation. Entrainment maneuvers were consistent with typical AVNRT. Slow pathway modification was performed, following which tachycardia was no longer inducible. Post-ablation, the device settings were returned to the primary prevention settings standard for our practice. On follow-up device interrogations, there have been no further episodes of tachycardia. The patient is relieved, but states that the anxiety caused by this experience has not completely resolved.


ICD discrimination of SVT versus VT with 1:1 V-A conduction: A review of the literature.

Cardoso RN, Healy C, Viles-Gonzalez J, Coffey JO - Indian Pacing Electrophysiol J (2016)

The above narrow complex tachycardia was reproducibly induced following an AH jump during an EP study. The characteristics of the tachycardia included a 1:1 V-A relationship, a negative V-A time, concentric atrial activation, and entrainment intervals consistent with typical AVNRT, thereby confirming the suspected diagnosis. Following slow pathway modification the tachycardia was no longer inducible. I, II, aVF, and V1 = surface electrograms; HRA p = high right atrial intracardiac electrogram; HBEP, HBEM, and HBED = His intracardiac electrograms (proximal, mid, and distal); CS 9–10, CS 7–8, CS 5–6, CS 3–4, and CS 1–2 = coronary sinus intracardiac electrograms (proximal to distal); RVAp = right ventricular apical intracardiac electrogram.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834441&req=5

fig4: The above narrow complex tachycardia was reproducibly induced following an AH jump during an EP study. The characteristics of the tachycardia included a 1:1 V-A relationship, a negative V-A time, concentric atrial activation, and entrainment intervals consistent with typical AVNRT, thereby confirming the suspected diagnosis. Following slow pathway modification the tachycardia was no longer inducible. I, II, aVF, and V1 = surface electrograms; HRA p = high right atrial intracardiac electrogram; HBEP, HBEM, and HBED = His intracardiac electrograms (proximal, mid, and distal); CS 9–10, CS 7–8, CS 5–6, CS 3–4, and CS 1–2 = coronary sinus intracardiac electrograms (proximal to distal); RVAp = right ventricular apical intracardiac electrogram.
Mentions: A diagnosis of AVNRT was strongly suspected on the retrospective review of the tachycardia episode, based on the short V-A time, the unchanged ventricular morphology on intracardiac electrograms, and the response to ATP. The patient was, therefore, scheduled for an electrophysiology (EP) study and possible radiofrequency catheter ablation. Meanwhile, in order to avoid further inappropriate shocks while awaiting the EP study, the VF zone was increased to greater than 233 bpm. At the EP study, dual AV nodal physiology was in fact revealed. A narrow complex tachycardia was reproducibly induced with single atrial extra-stimuli (Fig. 4). The tachycardia had a 1:1 VA relationship, a negative V-A time, and concentric atrial activation. Entrainment maneuvers were consistent with typical AVNRT. Slow pathway modification was performed, following which tachycardia was no longer inducible. Post-ablation, the device settings were returned to the primary prevention settings standard for our practice. On follow-up device interrogations, there have been no further episodes of tachycardia. The patient is relieved, but states that the anxiety caused by this experience has not completely resolved.

Bottom Line: They also impair patients' quality of life, increase hospitalizations, and raise health-care costs.V-A time, electrogram morphology, and response to antitachycardia pacing suggested atrioventricular nodal reentry tachycardia, which was confirmed in an electrophysiology study.Inspired by this case, we performed a literature review to discuss mechanisms for discrimination of supraventricular tachycardia with 1:1 A:V relationship from ventricular tachycardia with 1:1 retrograde conduction.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Division, Department of Medicine, University of Miami, Miller School of Medicine, Miami, USA.

ABSTRACT
Inappropriate ICD shocks are associated with increased mortality. They also impair patients' quality of life, increase hospitalizations, and raise health-care costs. Nearly 80% of inappropriate ICD shocks are caused by supraventricular tachycardia. Here we report the case of a patient who received a single-lead dual-chamber sensing ICD for primary prevention of sudden cardiac death and experienced inappropriate ICD shocks. V-A time, electrogram morphology, and response to antitachycardia pacing suggested atrioventricular nodal reentry tachycardia, which was confirmed in an electrophysiology study. Inspired by this case, we performed a literature review to discuss mechanisms for discrimination of supraventricular tachycardia with 1:1 A:V relationship from ventricular tachycardia with 1:1 retrograde conduction.

No MeSH data available.


Related in: MedlinePlus