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Ventriculoatrial Intervals: Diagnostic Use in Paroxysmal Supraventricular Tachycardia

DAVID G. BENDITT, M.D.; EDWARD L. C. PRITCHETT, M.D.; WILLIAM M. SMITH, Ph.D.; and JOHN J. GALLAGHER, M.D.
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Grant support: Supported in part by grants RR-30 from the General Clinical Research Branch, Division of Health Resources; and HL15190 from the National Institutes of Health, Bethesda, Maryland. This work was done in part during the tenure of Dr. Benditt as a Fellow of the Medical Research Council of Canada. Dr. Pritchett is the recipient of NHLBI Young Investigator Research Award 1R23 HL21347-01. This work was done during Dr. Gallagher's tenure as an Established Investigator of the American Heart Association.

▸Requests for reprints should be addressed to David G. Benditt, M.D.; Box 341, Mayo Building; University of Minnesota Medical School; Minneapolis, MN 55455.


Durham, North Carolina


© 1979 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1979;91(2):161-166. doi:10.7326/0003-4819-91-2-161
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Reciprocating tachycardias due to reentry either within the atrioventricular (AV) node or using an accessory AV pathway are a common cause of paroxysmal supraventricular tachycardia in humans. Unfortunately, although of potential therapeutic value, differentiation of these forms of reciprocating tachycardia may be difficult and require detailed electrophysiologic study. To develop diagnostic criteria that permit exclusion of participation of an accessory AV pathway in reciprocating tachycardia without extensive laboratory testing, results of electrophysiologic studies were examined in 50 patients with Wolff-Parkinson-White syndrome, 15 patients with accessory AV pathways that conducted only in the ventriculoatrial direction, and 15 patients with reentry within the AV node. The interval between onset of ventricular activation and both earliest recorded atrial activity (V-Amin) and high lateral right atrial electrogram (V-HRA) was measured during tachycardia. A V-Amin of 61 ms or less or V-HRA of 95 ms or less did not occur in patients with accessory AV pathways, but occurred frequently (12 of 15 and seven of eight, respectively) in patients with reentry within the AV node. Therefore, in patients with paroxysmal reciprocating tachycardias, V-A interval measurements provide a screening test capable of excluding participation of an accessory AV pathway.

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