What question did this study set out to answer?

Determine the precise electrophysiologic mechanism of an induced wide complex tachycardia mimicking atrioventricular nodal reentrant tachycardia after ventricular overdrive pacing.

August 31, 2023Journal of Cardiovascular ElectrophysiologyOpen Access

A wide complex tachycardia and response to ventricular overdrive pacing: What is the mechanism?

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Wide complex tachycardia (n=1). Intervention: Electrophysiology study and radiofrequency ablation. Primary outcome: Mechanism of tachycardia.

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Key result

EP mapping identifies WCT as CS ostial atrial tachycardia featuring a novel pseudo-pseudo VAAV response.

Design

Case report

Authors

SDSubrat DasWestchester Medical Center JRJonathan RamalhoWestchester Medical Center EHEthan HochWestchester Medical Center

Discussion

Member takes

Implication

Novel pseudo-pseudo VAAV response in atrial tachycardia warrants cautious EP maneuver interpretation; leaves broader applicability open beyond this case.

Key Points

Determine the precise electrophysiologic mechanism of an induced wide complex tachycardia mimicking atrioventricular nodal reentrant tachycardia after ventricular overdrive pacing.
Evaluated an electrophysiology study and interrogated a biventricular implantable cardioverter-defibrillator in a 69-year-old woman presenting with multiple shocks.
Assessed response to ventricular overdrive pacing, baseline electrophysiologic intervals, and retrograde ventriculoatrial conduction pathways.
Performed electroanatomic mapping and delivered radiofrequency catheter ablation within the coronary sinus ostium.
Ventricular overdrive pacing initially showed an apparent pseudo ventricle-atrium-atrium-ventricle response, simulating typical atrioventricular nodal reentrant tachycardia.
Post-pacing analysis revealed retrograde conduction over a bystander slow pathway followed by re-initiation of an atrial tachycardia rather than a reentrant circuit.
Targeted radiofrequency ablation 0.5 to 1.0 cm inside the coronary sinus ostium terminated the tachycardia and eliminated its re-inducibility.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

69-year-old woman with nonischemic cardiomyopathy (EF 35-40%), prior biventricular ICD, and prior ventricular tachycardia on mexiletine, presenting with wide complex tachycardia.

Intervention

Electrophysiology study and radiofrequency ablation

Outcome

Mechanism of tachycardia and ablation success

This case highlights a rare 'pseudo' pseudo VAAV response to ventricular overdrive pacing during atrial tachycardia, emphasizing the need for careful interpretation of electrophysiologic maneuvers.

Cite This Study

Das et al. (2023) conducted a case report in Wide complex tachycardia (n=1). Electrophysiology study and radiofrequency ablation was evaluated on Mechanism of tachycardia. Electrophysiology study and mapping revealed the wide complex tachycardia to be an atrial tachycardia originating near the coronary sinus ostium, demonstrating a novel pseudo pseudo VAAV response.

synapsesocial.com/papers/6a0ed80625c30b2cc7f9d3ca https://doi.org/10.1111/jce.16043

Topics

Ventricular arrhythmias Cardiac device therapy

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Implication

Novel pseudo-pseudo VAAV response in atrial tachycardia warrants cautious EP maneuver interpretation; leaves broader applicability open beyond this case.

A wide complex tachycardia and response to ventricular overdrive pacing: What is the mechanism?

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

A wide complex tachycardia and response to ventricular overdrive pacing: What is the mechanism?

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider