Incidence and prognostic significance of spontaneous and inducible antidromic tachycardia.

Abstract

AIMS:

Orthodromic atrioventricular reentrant tachycardia (ORT) is the most common arrhythmia at electrophysiological study (EPS) in patients with pre-excitation. The purpose of the study was to determine the clinical significance and the electrophysiological characteristics of patients with inducible antidromic tachycardia (ADT).

METHODS AND RESULTS:

Electrophysiological study was performed in 807 patients with a pre-excitation syndrome in control state and after isoproterenol. Antidromic tachycardia was induced in 63 patients (8%). Clinical and electrophysiological data were compared with those of 744 patients without ADT. Patients with and without ADT were similar in term of age (33 ± 18 vs. 34 ± 17), male gender (68 vs. 61%), clinical presentation with spontaneous atrioventricular reentrant tachycardia (AVRT) (35 vs. 42%), atrial fibrillation (AF) (3 vs. 3%), syncope (16 vs. 12%). In patients with induced ADT, asymptomatic patients were less frequent (24 vs. 37%; <0.04), spontaneous ADT and spontaneous malignant form more frequent (8 vs. 0.5%; <0.001) (16 vs. 6%; <0.002). Left lateral accessory pathway (AP) location was more frequent (51 vs. 36%; P < 0.022), septal location less frequent (40 vs. 56%; P < 0.01). And 1/1 conduction through AP was more rapid. Orthodromic AVRT induction was as frequent (55.5 vs. 55%), but AF induction (41 vs. 24%; P < 0.002) and electrophysiological malignant form were more frequent (22 vs. 12%; P < 0.02). The follow-up was similar; four deaths and three spontaneous malignant forms occurred in patients without ADT. When population was divided based on age (<20/≥20 years), the older group was less likely to have criteria for malignant form.

CONCLUSION:

Antidromic tachycardia induction is rare in pre-excitation syndrome and generally is associated with spontaneous or electrophysiological malignant form, but clinical outcome does not differ.

• Authors: Béatrice Brembilla-Perrot, Maheshwar Pauriah, Jean-Marc Sellal, Pierre Yves Zinzius, Jérôme Schwartz, Christian de Chillou, Gabriel Cismaru, Daniel Beurrier, Damien Voilliot, Olivier Selton, Pierre Louis, Marius Andronache, Radu Nosu, Arnaud Terrier de la Chaise
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 15 Issue 6 Pg. 871-6 (Jun 2013) ISSN: 1532-2092 [Electronic] England
• PMID: 23148120 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Age Distribution
• Aged
• Aged, 80 and over
• Cardiac Pacing, Artificial (statistics & numerical data)
• Child
• Child, Preschool
• Comorbidity
• Electrocardiography (statistics & numerical data)
• Electrophysiologic Techniques, Cardiac (statistics & numerical data)
• Female
• France (epidemiology)
• Humans
• Incidence
• Male
• Middle Aged
• Pre-Excitation Syndromes (diagnosis, epidemiology)
• Prognosis
• Reproducibility of Results
• Risk Assessment
• Sensitivity and Specificity
• Sexism
• Tachycardia, Atrioventricular Nodal Reentry (diagnosis, epidemiology)
• Young Adult