Determining the Site of Accessory Pathways in Orthodromic Reciprocating Tachycardia by Using the Response to Right Ventricular Pacing

BACKGROUND: Postpacing interval (PPI) after right ventricular (RV) pacing entrainment minus tachycardia cycle length (TCL) with a correction for atrioventricular (AV) node delay (corrected PPI-TCL) was useful to differentiate atrioventricular node reentrant tachycardia (AVNRT) from orthodromic reciprocating tachycardia (ORT). However, the value of corrected PPI-TCL in determining the site of the accessory pathway (AP) in ORT has not been investigated. The purpose of this study was to assess whether the corrected PPI-TCL is useful in differentiating ORT using a left-sided AP from a right-sided AP. METHODS: We studied 52 patients with ORT using a left-sided AP and 13 patients with a right-sided AP. The PPI was measured upon cessation of the RV pacing at a cycle length 10-40 ms shorter than the TCL. The corrected PPI-TCL was calculated from the subtraction of the increment in AV nodal conduction time of the first PPI from the PPI-TCL. RESULTS: The mean corrected PPI-TCL was 83 ± 20 ms in patients with ORT using a left-sided AP and 27 ± 19 ms in patients with a right-sided AP (P ≤ 0.001). All patients with ORT using a left-sided AP except three patients with left septal AP and none of the patients with ORT using a right-sided AP had a corrected PPI-TCL > 55 ms. CONCLUSIONS: The corrected PPI-TCL after the RV pacing entrainment is useful to guide differentiating ORT using a left-sided AP from a right-sided AP.