A Single Atrial Extrastimulation Resetting His Bundle During Supraventricular Tachycardia to Differentiate Atrial Tachycardia

Osamu Inaba; Yukihiro Inamura; Takamitsu Takagi; Shin Meguro; Kentaro Nakata; Toshiki Michishita; Yuhei Isonaga; Toshikazu Kono; Shinichi Tachibana; Takashi Ikenouchi; Hiroaki Ohya; Kazuya Murata; Tomomasa Takamiya; Akira Sato; Tetsuo Sasano

doi:10.1016/j.jacep.2024.02.007

A Single Atrial Extrastimulation Resetting His Bundle During Supraventricular Tachycardia to Differentiate Atrial Tachycardia

JACC Clin Electrophysiol. 2024 Mar 5:S2405-500X(24)00105-1. doi: 10.1016/j.jacep.2024.02.007. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan. Electronic address: oinbcvm@tmd.ac.jp.
² Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan.
³ Department of Cardiology, Kameda Medical Center, Kamogawa, Japan.
⁴ Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
⁵ Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.

PMID: 38551549
DOI: 10.1016/j.jacep.2024.02.007

Abstract

Background: Catheter ablation is the curative treatment for paroxysmal supraventricular tachycardia (SVT). However, atrial tachycardia (AT) diagnosis is often challenging, especially when SVT is terminated by pacing.

Objectives: This study sought to develop a novel method for AT diagnosis.

Methods: A total of 147 SVTs including 28 ATs, 87 atrioventricular nodal re-entrant tachycardias, and 32 orthodromic reciprocating tachycardias were prospectively studied. Single atrial extrastimulation was performed at the proximal coronary sinus from a coupling interval 20 milliseconds shorter than the tachycardia cycle length and gradually decreased until the His bundle (HB) was first reset and further until the SVT was terminated. The response of the SVT during the first HB resetting and the termination pattern were examined.

Results: In 27 of 28 ATs, tachycardia was unaffected when HB resetting whereas, in atrioventricular nodal re-entrant tachycardias or orthodromic reciprocating tachycardias (non-AT), tachycardia was simultaneously reset when HB resetting or was terminated with an atrio-Hisian block. When the coupling interval was further shortened for cases in which tachycardia persisted, all 33 SVTs with tachycardia termination with atrio-Hisian block were non-ATs, whereas 5 ATs and 7 non-ATs were terminated with Hisian-atrial block. The sensitivity, specificity, and positive and negative predictive values of the pattern of tachycardia that was unaffected when HB resetting for AT diagnosis were 96%, 100%, 100%, and 99%, respectively. Those of the pattern of tachycardia termination with atrio-Hisian block for non-AT diagnosis were 92%, 100%, 100%, and 42%, respectively.

Conclusions: Single atrial extrastimulation from the proximal coronary sinus during tachycardia was useful and effective for AT diagnosis.

Keywords: His bundle resetting; atrial tachycardia; single atrial extrastimulation; supraventricular tachycardia; tachycardia termination.