ヒグチ　サトシ   HIGUCHI Satoshi   樋口　諭    所属   医学部 医学科（東京女子医科大学病院）    職種   寄附部門講師
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Novel Diagnostic Observations of Nodoventricular/Nodofascicular Pathway-Related Orthodromic Reciprocating Tachycardia Differentiating From Atrioventricular Nodal Re-Entrant Tachycardia.
掲載誌名	正式名：JACC. Clinical electrophysiology 略　 称：JACC Clin Electrophysiol ISSNコード：24055018/2405500X
掲載区分	国外
巻・号・頁	6(14),pp.1797-1807
著者・共著者	Nagashima Koichi, Kaneko Yoshiaki, Maruyama Mitsunori, Nogami Akihiko, Kowase Shinya,, Mori Hitoshi, Sumitomo Naokata, Fukamizu Seiji,, Hojo Rintaro,, Kitamura Takeshi, Soejima Kyoko, Ueda Akiko, Otsuka Takayuki, Takam Mitsuru, Tanimoto Kojiro, Asakawa Tetsuya, Kumagai Kenta, Tamura Shuntaro, Hasegawa Hiroshi, Ogura Kazuyoshi, Kawamura Mitsuharu, Munetsugu Yumi, Shoda Morio, Higuchi Satoshi, Kanazawa Hisanori, Kusa Shigeki, Mizukami Akira, Miyazaki Shinsuke, Wakamatsu Yuji,, Okumura Yasuo
発行年月	2020/12
概要	OBJECTIVES:This study sought to assess the performance of current diagnostic criteria and identify additional electrophysiological features differentiating orthodromic reciprocating tachycardia (ORT) with a concealed nodoventricular/nodofascicular (NV/NF) pathway from atrioventricular nodal re-entrant tachycardia (AVNRT).BACKGROUND:Diagnosing sustained supraventricular tachycardia (SVT) despite the occurrence of ventriculoatrial block (VAB) is challenging.METHODS:We analyzed electrograms of 25 sustained SVTs (9 NV/NF-ORTs [n = 7/2] and 16 AVNRTs) with VAB and 91 AVNRTs without VAB (for reference).RESULTS:More than 1 SVT, each with a different ventriculoatrial interval, was commonly induced in AVNRT cases (75%) but not in NV/NF-ORT cases (0%; p = 0.0005). Wenckebach VAB was common in NV/NF-ORTs (78%), but VAB patterns varied in AVNRTs. The His-His interval transiently prolonged in the following beat after the VAB in most AVNRTs but rarely did in NV/NF-ORTs (79% vs. 22%; p = 0.01). NV/NF-ORT was diagnosed by His-refractory premature ventricular contractions (n = 5) and the findings during right ventricular overdrive pacing showing an uncorrected/corrected post-pacing interval (PPI)-tachycardia cycle length (TCL) ≤115/110 ms (n = 5/5), orthodromic His capture (n = 6), and V-V-A (ventricle-ventricle-atrial response) response (n = 3). A single form of induced SVT (positive predictive value [PPV]: 69%; negative predictive value [NPV]: 100%), Wenckebach VAB (PPV: 70%; NPV: 87%), stable His-His interval despite VAB (PPV: 70%; NPV: 85%), orthodromic His capture (PPV: 100%; NPV: 97%), and V-V-A response (PPV: 100%; NPV: 95%) characterized NV/NF-ORT, and a PPI-TCL of ≤125 ms (PPV: 100%; NPV: 100%) characterized NV-ORT.CONCLUSIONS:Induction of a single SVT form, Wenckebach VAB, stable His-His interval despite VAB, orthodromic His capture, and V-V-A response appeared to discriminate NV/NF-ORT from AVNRT, with a PPI-TCL of ≤125 ms discriminating NV-ORT from NF-ORT and AVNRT.
DOI	10.1016/j.jacep.2020.07.007
PMID	33357576