Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 3, Number 1, February 2012, pages 28-33

Choice and Utility of Pacing Maneuver in Establishing the Mechanism of Supraventricular Tachycardia: A Single Center Experience

**Table 1.** Baseline Patients Characteristic
	Total (n = 160)	AVNRT(n = 84)	AT (n = 29)	ORT (n = 47)	P-value
Values reported as mean ± SD; * Statistically significant difference between ORT and other two groups.
Age yrs	50.3 ± 17.5	53.0 ± 16.8	59.2 ± 14.4	40.2 ± 15.8	< 0.001*
Female Gender n (%)	91 (57%)	50 (60%)	18 (62%)	23 (50%)	0.41
Race (white) n (%)	143 (89%)	75 (89%)	27 (93%)	41 (87%)	0.34
CAD n (%)	27 (17%)	18 (21%)	7 (24%)	2 (4%)	0.02*
Beta blocker use n (%)	82 (51%)	46 (55%)	17 (59%)	19 (40%)	0.20
Calcium-channel blockers n (%)	28 (18%)	18 (21%)	9 (31%)	1(2.1%)	0.002*
Anti-Arrhythmics n (%)	29 (18%)	18 (21%)	6 (21%)	5 (11%)	0.28
Ejection Fraction (%)	54 ± 13	55 ± 12	47 ± 18	57 ± 8	0.14
Common Symptoms
Palpitations	94 (64%)	50 (63%)	15 (63%)	29 (66%)	0.09 0.19 0.23
Syncope	15 (10%)	10 (13%)	2 (8%)	3 (7%)	0.09 0.19 0.23
Dizziness	21 (14%)	14 (18%)	0	7 (16%)	0.09 0.19 0.23

Table 1. Baseline Patients Characteristic

Total (n = 160)

AVNRT(n = 84)

AT (n = 29)

ORT (n = 47)

P-value

Values reported as mean ± SD; * Statistically significant difference between ORT and other two groups.

Age yrs

50.3 ± 17.5

53.0 ± 16.8

59.2 ± 14.4

40.2 ± 15.8

< 0.001*

Female Gender n (%)

91 (57%)

50 (60%)

18 (62%)

23 (50%)

0.41

Race (white) n (%)

143 (89%)

75 (89%)

27 (93%)

41 (87%)

0.34

CAD n (%)

27 (17%)

18 (21%)

7 (24%)

2 (4%)

0.02*

Beta blocker use n (%)

82 (51%)

46 (55%)

17 (59%)

19 (40%)

0.20

Calcium-channel blockers n (%)

28 (18%)

18 (21%)

9 (31%)

1(2.1%)

0.002*

Anti-Arrhythmics n (%)

29 (18%)

18 (21%)

6 (21%)

5 (11%)

0.28

Ejection Fraction (%)

54 ± 13

55 ± 12

47 ± 18

57 ± 8

0.14

Common Symptoms

Palpitations

94 (64%)

50 (63%)

15 (63%)

29 (66%)

0.09 0.19 0.23

Syncope

15 (10%)

10 (13%)

2 (8%)

3 (7%)

0.09 0.19 0.23

Dizziness

21 (14%)

14 (18%)

7 (16%)

0.09 0.19 0.23

**Table 2.** Baseline EP Characteristics
	Total	AVNRT	AT	ORT	P-value
^§P-value represents difference between ORT and other two groups, no statistically difference between AT and AVNRT; ^¥difference between AT and ORT.
CL (ms)	843 ± 189	854 ± 165	779 ± 227	861 ± 202	0.254
PR interval (ms)	151 ± 40	164 ± 35	173 ± 31	116 ± 31	< 0.001^§
QRS interval (ms)	101 ± 38	88 ± 17	97 ± 24	128 ± 56	< 0.001^§
QT interval (ms)	398 ± 57	396 ± 41	402 ± 47	400 ± 82	0.105
AH Interval (ms)	86 ± 32	86 ± 29	96 ± 30	81 ± 37	0.01^¥
HV interval (ms)	42 ± 23	51 ± 18	49 ± 10	21 ± 23	< 0.001^§
AV Wenckebach (ms)	370 ± 74	375 ± 74	387 ± 76	331 ± 56	0.018^§
VA wenckebach (ms)	412 ± 114	398 ± 98	478 ± 154	394 ± 114	0.184
Presence of Pre-excitation (%)	20	0	0	79	< 0.001

Table 2. Baseline EP Characteristics

Total

AVNRT

ORT

P-value

^§P-value represents difference between ORT and other two groups, no statistically difference between AT and AVNRT; ^¥difference between AT and ORT.

CL (ms)

843 ± 189

854 ± 165

779 ± 227

861 ± 202

0.254

PR interval (ms)

151 ± 40

164 ± 35

173 ± 31

116 ± 31

< 0.001^§

QRS interval (ms)

101 ± 38

88 ± 17

97 ± 24

128 ± 56

< 0.001^§

QT interval (ms)

398 ± 57

396 ± 41

402 ± 47

400 ± 82

0.105

AH Interval (ms)

86 ± 32

86 ± 29

96 ± 30

81 ± 37

0.01^¥

HV interval (ms)

42 ± 23

51 ± 18

49 ± 10

21 ± 23

< 0.001^§

AV Wenckebach (ms)

370 ± 74

375 ± 74

387 ± 76

331 ± 56

0.018^§

VA wenckebach (ms)

412 ± 114

398 ± 98

478 ± 154

394 ± 114

0.184

Presence of Pre-excitation (%)

< 0.001

**Table 3.** SVT Characteristics
	Total	AVNRT	AT	ORT	P-value
CL = cycle length; * Statistically significant difference between all the three groups.
CL (ms)	351 ± 84	350 ± 70	388 ± 106	325 ± 89	0.10
% Aberrancy
Left Bundle	29%	25%	67%	20%	0.002
Right Bundle	13%	0	0	60%
Septal VA interval (ms)	68 ± 86	28 ± 50	252 ± 58	135 ± 73	< 0.001*
AH Interval (ms)	200 ± 113	218 ± 128	146 ± 48	164 ± 47	0.172
HV interval (ms)	64 ± 25	69 ± 27	59 ± 11	48 ± 10	0.470
Isoproterenol required to sustain tachycardia	43%	48%	64%	24%	0.06
Ablation Success (%)	96	99	83	98	0.003
Eccentric atrial activation (%)	20	1	56	65	0.18

Table 3. SVT Characteristics

Total

AVNRT

ORT

P-value

CL = cycle length; * Statistically significant difference between all the three groups.

CL (ms)

351 ± 84

350 ± 70

388 ± 106

325 ± 89

0.10

% Aberrancy

Left Bundle

29%

25%

67%

20%

0.002

Right Bundle

13%

60%

Septal VA interval (ms)

68 ± 86

28 ± 50

252 ± 58

135 ± 73

< 0.001*

AH Interval (ms)

200 ± 113

218 ± 128

146 ± 48

164 ± 47

0.172

HV interval (ms)

64 ± 25

69 ± 27

59 ± 11

48 ± 10

0.470

Isoproterenol required to sustain tachycardia

43%

48%

64%

24%

0.06

Ablation Success (%)

0.003

Eccentric atrial activation (%)

0.18

**Table 4.** Pacing Maneuvers During Normal Sinus Rhythm
	% of Total	% Within SVT
Echo beats during premature atrial stimulation	24	85	13	67
AH Jump during premature atrial stimulation	33	87	25	25
Extranodal response to para Hisian pacing	2.2	0	0	100

Table 4. Pacing Maneuvers During Normal Sinus Rhythm

% of Total

% Within SVT

AVNRT

ORT

Echo beats during premature atrial stimulation

AH Jump during premature atrial stimulation

Extranodal response to para Hisian pacing

2.2

100

**Table 5.** Pacing Maneuvers During SVT and Diagnostic Utility
	Total (n)	AVNRT (n)	AT (n)	ORT (n)
Ventricular pacing at 10 – 40 ms < SVT CL	96	66	12	18
Entrainment	68	48	5	15
• VAAV Pattern		1	5	0
• VAV pattern		47	0	15
Dissociation	19	12	7	0
Termination	8	6	0	2
Diagnostic yield		71%	42%	83%
His Refractory PVC	39	24	1	14
• Entrainment of Atrium		0	0	11
• Termination		1	0	3
Diagnostic Yield		96%	n/a	100%

Table 5. Pacing Maneuvers During SVT and Diagnostic Utility

Total (n)

AVNRT (n)

AT (n)

ORT (n)

Ventricular pacing at 10 – 40 ms < SVT CL

Entrainment

• VAAV Pattern

• VAV pattern

Dissociation

Termination

Diagnostic yield

71%

42%

83%

His Refractory PVC

• Entrainment of Atrium

• Termination

Diagnostic Yield

96%

n/a

100%

**Table 6.** Physician Choice of Pacing Maneuver
Physician	AVNRT	AT	ORT
V-pacing: ventricular pacing at 10 - 40 ms < SVT CL; PVS: His-refractory Premature stimulus.
1	88.9	33.3	75	25	80	40
2	91.7	45.8	14.3	0	41.7	41.7
3	85.7	0	33.3	0	0	0
4	21.4	0	25	0	0	0
5	87.5	37.5	75	0	42.9	28.8
6	90.9	54.5	0	0	33.3	22.2
7	100	0	0	0	50	50
8	50	50	100	0	25	25
P-value	< 0.001	0.013	0.147	0.543	0.380	0.757

Table 6. Physician Choice of Pacing Maneuver

Physician

AVNRT

ORT

V-pacing (%)

PVS (%)

V-pacing (%)

PVS (%)

V-pacing (%)

PVS (%)

V-pacing: ventricular pacing at 10 - 40 ms < SVT CL; PVS: His-refractory Premature stimulus.

88.9

33.3

91.7

45.8

14.3

41.7

85.7

33.3

21.4

87.5

37.5

42.9

28.8

90.9

54.5

33.3

22.2

100

P-value

< 0.001

0.013

0.147

0.543

0.380

0.757