Ventriculoatrial conduction in patients without high-grade AV block: when is it present?

Claude S. Elayi, Gustavo Morales, Muhammad Butt, Jignesh Shah, Gbolahan Ogunbayo, Naoki Misumida, John Catanzaro, Luigi Di Biase, Andrea Natale, Brian Delisle, Yousef Darrat

Research output: Contribution to journalArticle

Abstract

Introduction: Ventriculoatrial (VA) conduction is a critical component in many arrhythmias, has a diagnostic value in electrophysiology study (EPS), and is implicated in pacemaker-mediated arrhythmias. This study sought to characterize retrograde conduction during EPS and to utilize it as a diagnostic tool in patients without AV block. Methods and results: Patients with intact AV conduction undergoing EPS were included in this study to systematically evaluate baseline VA conduction. If absent, parahisian pacing was used to determine the level of block (nodal or infranodal). Recovery of VA conduction with increased sympathetic activity was assessed with isoproterenol infusion. Baseline characteristics and electrophysiological data were collected and analyzed. Among the 801 patients studied, VA conduction was present in 98% (81% at baseline and 17% after isoproterenol infusion). Parahisian pacing demonstrated that the block was at the AV node level among 150 patients with VA dissociation at baseline. Among patients presenting with supraventricular tachycardia (SVT), 98.7% with atrioventricular nodal reentrant tachycardia (AVNRT) had VA conduction at baseline versus 82.7% presenting with other SVT (atrial fibrillation excluded), P < 0.001. Thus, the absence of VA conduction at baseline during an EPS for SVT carries a negative predictive value (NPV) of 96.9% for AVNRT. Conclusions: VA conduction is present in most patients (98%) with intact AV conduction. The level of VA dissociation when present at baseline is always at the level of the AV node. Patients with SVT presenting for EPS that lacked VA conduction at baseline were unlikely to have AVNRT.

Original languageEnglish (US)
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Atrioventricular Block
Electrophysiology
Supraventricular Tachycardia
Atrioventricular Nodal Reentry Tachycardia
Atrioventricular Node
Isoproterenol
Cardiac Arrhythmias
Atrial Fibrillation

Keywords

  • Atrioventricular nodal reentry tachycardia
  • Supraventricular tachycardia
  • Ventriculoatrial conduction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ventriculoatrial conduction in patients without high-grade AV block : when is it present? / Elayi, Claude S.; Morales, Gustavo; Butt, Muhammad; Shah, Jignesh; Ogunbayo, Gbolahan; Misumida, Naoki; Catanzaro, John; Di Biase, Luigi; Natale, Andrea; Delisle, Brian; Darrat, Yousef.

In: Journal of Interventional Cardiac Electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

Elayi, Claude S. ; Morales, Gustavo ; Butt, Muhammad ; Shah, Jignesh ; Ogunbayo, Gbolahan ; Misumida, Naoki ; Catanzaro, John ; Di Biase, Luigi ; Natale, Andrea ; Delisle, Brian ; Darrat, Yousef. / Ventriculoatrial conduction in patients without high-grade AV block : when is it present?. In: Journal of Interventional Cardiac Electrophysiology. 2019.
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title = "Ventriculoatrial conduction in patients without high-grade AV block: when is it present?",
abstract = "Introduction: Ventriculoatrial (VA) conduction is a critical component in many arrhythmias, has a diagnostic value in electrophysiology study (EPS), and is implicated in pacemaker-mediated arrhythmias. This study sought to characterize retrograde conduction during EPS and to utilize it as a diagnostic tool in patients without AV block. Methods and results: Patients with intact AV conduction undergoing EPS were included in this study to systematically evaluate baseline VA conduction. If absent, parahisian pacing was used to determine the level of block (nodal or infranodal). Recovery of VA conduction with increased sympathetic activity was assessed with isoproterenol infusion. Baseline characteristics and electrophysiological data were collected and analyzed. Among the 801 patients studied, VA conduction was present in 98{\%} (81{\%} at baseline and 17{\%} after isoproterenol infusion). Parahisian pacing demonstrated that the block was at the AV node level among 150 patients with VA dissociation at baseline. Among patients presenting with supraventricular tachycardia (SVT), 98.7{\%} with atrioventricular nodal reentrant tachycardia (AVNRT) had VA conduction at baseline versus 82.7{\%} presenting with other SVT (atrial fibrillation excluded), P < 0.001. Thus, the absence of VA conduction at baseline during an EPS for SVT carries a negative predictive value (NPV) of 96.9{\%} for AVNRT. Conclusions: VA conduction is present in most patients (98{\%}) with intact AV conduction. The level of VA dissociation when present at baseline is always at the level of the AV node. Patients with SVT presenting for EPS that lacked VA conduction at baseline were unlikely to have AVNRT.",
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T1 - Ventriculoatrial conduction in patients without high-grade AV block

T2 - when is it present?

AU - Elayi, Claude S.

AU - Morales, Gustavo

AU - Butt, Muhammad

AU - Shah, Jignesh

AU - Ogunbayo, Gbolahan

AU - Misumida, Naoki

AU - Catanzaro, John

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Delisle, Brian

AU - Darrat, Yousef

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Ventriculoatrial (VA) conduction is a critical component in many arrhythmias, has a diagnostic value in electrophysiology study (EPS), and is implicated in pacemaker-mediated arrhythmias. This study sought to characterize retrograde conduction during EPS and to utilize it as a diagnostic tool in patients without AV block. Methods and results: Patients with intact AV conduction undergoing EPS were included in this study to systematically evaluate baseline VA conduction. If absent, parahisian pacing was used to determine the level of block (nodal or infranodal). Recovery of VA conduction with increased sympathetic activity was assessed with isoproterenol infusion. Baseline characteristics and electrophysiological data were collected and analyzed. Among the 801 patients studied, VA conduction was present in 98% (81% at baseline and 17% after isoproterenol infusion). Parahisian pacing demonstrated that the block was at the AV node level among 150 patients with VA dissociation at baseline. Among patients presenting with supraventricular tachycardia (SVT), 98.7% with atrioventricular nodal reentrant tachycardia (AVNRT) had VA conduction at baseline versus 82.7% presenting with other SVT (atrial fibrillation excluded), P < 0.001. Thus, the absence of VA conduction at baseline during an EPS for SVT carries a negative predictive value (NPV) of 96.9% for AVNRT. Conclusions: VA conduction is present in most patients (98%) with intact AV conduction. The level of VA dissociation when present at baseline is always at the level of the AV node. Patients with SVT presenting for EPS that lacked VA conduction at baseline were unlikely to have AVNRT.

AB - Introduction: Ventriculoatrial (VA) conduction is a critical component in many arrhythmias, has a diagnostic value in electrophysiology study (EPS), and is implicated in pacemaker-mediated arrhythmias. This study sought to characterize retrograde conduction during EPS and to utilize it as a diagnostic tool in patients without AV block. Methods and results: Patients with intact AV conduction undergoing EPS were included in this study to systematically evaluate baseline VA conduction. If absent, parahisian pacing was used to determine the level of block (nodal or infranodal). Recovery of VA conduction with increased sympathetic activity was assessed with isoproterenol infusion. Baseline characteristics and electrophysiological data were collected and analyzed. Among the 801 patients studied, VA conduction was present in 98% (81% at baseline and 17% after isoproterenol infusion). Parahisian pacing demonstrated that the block was at the AV node level among 150 patients with VA dissociation at baseline. Among patients presenting with supraventricular tachycardia (SVT), 98.7% with atrioventricular nodal reentrant tachycardia (AVNRT) had VA conduction at baseline versus 82.7% presenting with other SVT (atrial fibrillation excluded), P < 0.001. Thus, the absence of VA conduction at baseline during an EPS for SVT carries a negative predictive value (NPV) of 96.9% for AVNRT. Conclusions: VA conduction is present in most patients (98%) with intact AV conduction. The level of VA dissociation when present at baseline is always at the level of the AV node. Patients with SVT presenting for EPS that lacked VA conduction at baseline were unlikely to have AVNRT.

KW - Atrioventricular nodal reentry tachycardia

KW - Supraventricular tachycardia

KW - Ventriculoatrial conduction

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U2 - 10.1007/s10840-019-00658-0

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JO - Journal of Interventional Cardiac Electrophysiology

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