Utility of atrial and ventricular cycle length variability in determining the mechanism of paroxysmal supraventricular tachycardia
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INTRODUCTION: No prior studies have systematically investigated the diagnostic value of cycle length (CL) variability in differentiating the mechanism of paroxysmal supraventricular tachycardia (PSVT). METHODS AND RESULTS: We studied 173 consecutive patients with PSVT; 86 typical atrioventricular nodal reentrant tachycardia (AVNRT), 11 atypical AVNRT, 47 orthodromic reciprocating tachycardia (ORT), and 29 with atrial tachycardia (AT). Two consecutive atrial cycles that displayed the most CL variability were selected for analysis. One hundred and twenty-six patients (73%) had > or = 15 msec variability in tachycardia CL. The change in atrial CL predicted the change in subsequent ventricular CL in six of eight patients (75%) with atypical AVNRT, 18 of 21 patients (86%) with AT, in none of 66 patients with typical AVNRT, and in 32 patients with ORT. The change in atrial CL was predicted by the change in preceding ventricular CL in 55 of 66 patients (83%) with typical AVNRT, no patient with atypical AVNRT, 27 of 31 patients (87%) with ORT, and one of 21 patients (5%) with AT. The sensitivity, specificity, and positive and negative predictive values of a change in atrial CL predicting the change in ventricular CL for AT or atypical AVNRT were 83%, 100%, 100%, and 95%, respectively. The corresponding values for the change in atrial CL being predicted by the change in the preceding ventricular CL for typical AVNRT or ORT were 85%, 97%, 99%, and 65%, respectively. CONCLUSION: Tachycardia CL variability > or = 15 msec is common in PSVT. A change in atrial CL that predicts the change in subsequent ventricular CL strongly favors AT or atypical AVNRT. A change in atrial CL that is predicted by the change in the preceding ventricular CL favors typical AVNRT or ORT.
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A change in ventricular cycle length preceding the change in subsequent atrial cycle length favours typical AVNRT or AVRT.
“A change in ventricular CL preceding the change in subsequent atrial CL favours typical AVNRT or AVRT.19”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [19]
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- Authors
- CRAWFORD, T. C., MUKERJI, S., GOOD, E., CHUGH, A., BOGUN, F., PELOSI, F., ORAL, H., MORADY, F., & JONGNARANGSIN, K.
- Affiliations
- Michigan Medicine (US)
- University of Michigan (US)
- Corresponding author
- JONGNARANGSIN, KRIT
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2007-05-30
- Volume
- 18
- Issue
- 7
- Pages
- 698-703
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2110910265
- Cited by
- 38
- References
- 16
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 6 · 2017: 3 · 2016: 3 · 2015: 2 · 2013: 3 · 2012: 3
- FWCI
- 2.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- paroxysmal supraventricular tachycardia, cycle length variability, atrial cycle length, ventricular cycle length, atrioventricular nodal reentrant tachycardia, orthodromic reciprocating tachycardia, atrial tachycardia
- MeSH terms
- Adult, Female, Heart Rate, Humans, Male, Middle Aged, Retrospective Studies, Tachycardia, Supraventricular, Atrial Function, Ventricular Function
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