Diagnostic Pacing Maneuvers for Supraventricular Tachycardias: Part 2

The approach to supraventricular tachycardia (SVT) diagnosis can be complex because it involves synthesizing baseline electrophysiologic features, features of the SVT, and the response(s) to pacing maneuvers. In this two-part review, we will mainly explore the latter while recognizing that neither of the former can be ignored, for they provide the context in which diagnostic pacing maneuvers must be correctly chosen and interpreted. Part 1 involved a detailed consideration of ventricular overdrive pacing, since this pacing maneuver provides the diagnosis in the majority of cases. In Part 2, other diagnostic pacing maneuvers that might be helpful when ventricular overdrive pacing is not diagnostic or appropriate, including attempts to reset SVT with single atrial or ventricular beats, para-Hisian pacing, apex versus base pacing, and atrial overdrive pacing, are discussed, as are some specific diagnostic SVT challenges encountered in the electrophysiology lab. There is considerable literature on this topic, and this review is by no means meant to be all-encompassing. Rather, we hope to clearly explain and illustrate the physiology, strengths, and weaknesses of what we consider to be the most important and commonly employed diagnostic pacing maneuvers, that is, those that trainees in cardiac electrophysiology should be well familiar with at a minimum.