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• W307016853 abstract "We read with great interest the article by González-Torrecilla et al 1 González-Torrecilla E. Arenal A. Atienza F. Osca J. García-Fernández J. Puchol A. Sánchez A. Almendral J. First postpacing interval after tachycardia entrainment with correction for atrioventricular node delay: a simple maneuver for differential diagnosis of atrioventricular nodal reentrant tachycardias versus orthodromic reciprocating tachycardias. Heart Rhythm. 2006; 3: 674-679 Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar in the June 2006 issue of Heart Rhythm. This is an excellent refinement of the postpacing interval—tachycardia cycle length (PPI-TCL) and stimulus-atrial—ventriculoatrial (SA-VA) criteria we first proposed for differentiating septal orthodromic reciprocating tachycardia (ORT) from atypical atrioventricular nodal reentrant tachycardia (AVNRT). 2 Michaud G.F. Tada H. Chough S. Baker R. Wasmer K. Sticherling C. Oral H. Pelosi Jr, F. Knight B.P. Strickberger S.A. Morady F. Differentiation of atypical atrioventricular node reentrant tachycardia from orthodromic reciprocating tachycardia using a septal accessory pathway by the response to ventricular pacing. J Am Coll Cardiol. 2001; 38: 1163-1167 Abstract Full Text Full Text PDF PubMed Scopus (197) Google Scholar We would like to make a few comments. First, the authors report 5of 31 patients with septal ORT who had a PPI-TCL >115 ms (our original criteria), but they used right ventricular (RV) pacing cycle lengths 20 to 40 ms below the TCL. In our experience, exceptions to the PPI-TCL criteria using 115 ms as a cutoff are rare when one paces 10 to 20 ms shorter than the TCL. We have not seen an exception for septal ORT when the PPI-TCL is <115 ms. The rare exception we have seen for septal ORT with a PPI-TCL >115 ms was due to dual anterograde AV nodal pathways. Conduction over the slow pathway followed entrainment from the RV apex with resumption of septal ORT over the fast AV nodal pathway. The resulting difference in AH caused a long PPI. By observing the SA-VA interval <85 ms in that case, we were able to correctly diagnose septal ORT. 3 Michaud G.F. Entrainment of a narrow QRS complex tachycardia from the RV apex: what is the mechanism?. Heart Rhythm. 2005; 2: 559-560 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Second, most patients with AVNRT in the present study (87/109) had the typical form, and the PPI-TCL is not necessary for those patients because ORT is excluded by a VA time <70 ms. Third, patients with a left free-wall accessory pathway do not present a diagnostic dilemma because of eccentric activation. To the EditorHeart RhythmVol. 3Issue 9PreviewWe would like to make a few comments on the interesting observations made by Drs. Michaud and Morady. First, in our opinion, an easier detection of clear entrainment is obtained with a pacing cycle length 20 to 40 ms shorter than the TCL. In addition, based on our experience from 22 consecutive patients with atypical AVNRT and 36 consecutive patients with ORT through a septal concealed accessory pathway, a PPI-TCL difference <115 ms without correction for AV nodal delay would result in a decrease of sensitivity for the diagnosis of the latter tachycardia mechanism (78% vs 100% with the appropriate correction; Figure 1). Full-Text PDF" @default.
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• W307016853 date "2006-09-01" @default.
• W307016853 modified "2023-09-25" @default.
• W307016853 title "To the Editor" @default.
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• W307016853 doi "https://doi.org/10.1016/j.hrthm.2006.06.022" @default.
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