• David K Singh, Mohan N Viswanathan, Ronn E Tanel, Randall J Lee, Byron K Lee, Gregory M Marcus, Jeffrey E Olgin, Frederick Han, Vasanth Vedantham, Zian H Tseng, Cara Pellegrini, Mitsuharu Kawamura, Edward P Gerstenfeld, Nitish Badhwar, and Melvin Scheinman.
• Division of Cardiology, Queens Medical Center, Honolulu, Hawaii. Electronic address: dsingh@queens.org.
• Heart Rhythm. 2014 Aug 1; 11 (8): 1327-35.

BackgroundBecause the His bundle is intrinsic to the circuit in orthodromic reciprocating tachycardia and remote from that of atrioventricular nodal reentrant tachycardia (AVNRT), pacing the His bundle during supraventricular tachycardia (SVT) may be useful to distinguish these arrhythmias.ObjectiveThe purpose of this study was to test the hypothesis that His overdrive pacing (HOP) would affect SVT immediately for orthodromic reciprocating tachycardia and in a delayed manner for AVNRT.MethodsOnce SVT was induced, HOP was performed by pacing the His bundle 10-30 ms faster than the SVT cycle length. The maneuver was determined to have entered the tachycardia circuit when a nonfused His-capture beat advanced or delayed the subsequent atrial electrogram by ≥10 ms or when the tachycardia was terminated. The number of beats required to enter each tachycardia with HOP was recorded.ResultsHOP was performed during 66 SVTs (26 atrioventricular reciprocating tachycardia [AVRT] and 40 AVNRT). Entry into the tachycardia within 1 beat had sensitivity of 92%, specificity of 92%, positive predictive value (PPV) of 89% and negative predictive value (NPV) of 95% to confirm the diagnosis of AVRT. A cutoff ≥3 beats to enter the circuit had sensitivity of 90%, specificity of 92%, PPV of 95% and NPV of 86% to confirm the diagnosis of AVNRT. HOP had sensitivity, specificity, PPV, and NPV of 100% for distinguishing septal AVRT from atypical AVNRT.ConclusionHOP during SVT is a novel technique for distinguishing orthodromic reciprocating tachycardia from AVNRT. It can reliably distinguish between these arrhythmias with high sensitivity and specificity.Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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