Heart rhythm : the official journal of the Heart Rhythm Society
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Differentiating atrioventricular nodal reentrant tachycardia (AVNRT) from orthodromic atrioventricular reentrant tachycardia (AVRT) can be difficult. The His bundle and atria are activated sequentially over the AV node during entrainment of AVNRT from the ventricle but simultaneously during supraventricular tachycardia (SVT). They are activated in parallel during entrainment of AVRT but sequentially during SVT. ⋯ The DeltaHA criterion during entrainment of tachycardia from the ventricle reliably differentiates AVNRT (positive values) from AVRT (negative values).
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Comparative Study
New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia.
We recently reported an ECG algorithm for differential diagnosis of regular wide QRS complex tachycardias that was superior to the Brugada algorithm. ⋯ The simplified aVR algorithm classified wide QRS complex tachycardias with the same accuracy as standard criteria and our previous algorithm and was superior to the Brugada algorithm.
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There is a close anatomical relationship between the right coronary cusp (RCC) and noncoronary aortic cusp (NCC) and sites recording His bundle (HB) activation in the right ventricle (RV). ⋯ VAs originating near the HB have similar electrocardiographic and electrophysiological characteristics, regardless of whether the ablation site is in the RV or aortic sinuses because of the close anatomical relationship of these structures and rapid transseptal conduction. When RV mapping reveals an earliest ventricular activation in the HB region during VAs, mapping in the RCC and NCC should be added to accurately identify the site of origin.