Role of Programmed Ventricular Extrastimulation in Differentiating Atrioventricular Nodal Re-entrant and Atrioventricular Re-entrant Tachycardias in Supraventricular Tachycardias

Momina Najam; Muhammad  Shabbir; Qurban Hussain Khan; Atif  Rauf; Waheed  Ur Rehman

doi:10.51253/pafmj.v75i6.13937

Authors

Momina Najam Department of Cardiology, Armed Institute of Cardiology/National Institute of Heart Disease National University of Medical Sciences (NUMS) Rawalpindi
Muhammad Shabbir Department of Cardiology, Armed Institute of Cardiology/National Institute of Heart Disease National University of Medical Sciences (NUMS) Rawalpindi
Qurban Khan Department of Cardiology, Armed Institute of Cardiology/National Institute of Heart Disease National University of Medical Sciences (NUMS) Rawalpindi
Atif Rauf Department of Cardiology, Armed Institute of Cardiology/National Institute of Heart Disease National University of Medical Sciences (NUMS) Rawalpindi
Waheed Ur Rehman Department of Cardiology, Armed Institute of Cardiology/National Institute of Heart Disease National University of Medical Sciences (NUMS) Rawalpindi

DOI:

https://doi.org/10.51253/pafmj.v75i6.13937

Keywords:

Atrioventricular Nodal Re-entry. Re-entrant, Sensitivity and Specificity, Stimulus, Supraventricular tachycardia

Abstract

Objective: To evaluate the diagnostic effectiveness of Programmed Ventricular Extrastimulus (PVE) during supraventricular tachycardia (SVT) in differentiating atrioventricular nodal re-entrant tachycardia (AVNRT) from atrioventricular re-entrant tachycardia (AVRT).

Study Design: Analytical Cross-Sectional Study

Place and Duration of Study: Electrophysiology Department, Armed Institute of Cardiology/National Institute of Heart Disease, Rawalpindi, Pakistan, from Mar to Aug 2025

Methodology: A total of 180 adult patients (aged ≥18 years) of either gender with suspected or documented supraventricular tachycardia (SVT) or inducible tachycardia during an electrophysiology (EPS) study were enrolled. Both ventricular entrainment and PVE (V2) pacing techniques were applied to record electrophysiological parameters, including stimulus-to-atrial minus ventriculoatrial (SA-VA) time and post-pacing interval minus tachycardia cycle length (PPI–TCL). Based on EPS findings, patients were classified into two groups: AVNRT (n=90) and AVRT (n=90).

Results: Among 180 patients, the AVNRT group included 53 males (58.9%), and the AVRT group had 64 males (71.1%). The mean age was 45.50 ± 15.31 years in the AVNRT group and 34.29 ± 11.78 years in the AVRT group (p<0.001). AVNRT patients exhibited significantly longer PR intervals (168.59 ± 9.81 ms) and shorter VA intervals during SVT (53.47 ± 7.94 ms) compared to AVRT patients (145.33 ± 12.58 ms and 166.1 ± 9.91 ms, respectively; p<0.001). Using the V2 technique, an SA–VA interval cutoff of 92.00 ms achieved 100% sensitivity and specificity for differentiating AVNRT from AVRT, with an AUC of 1.00 (95% CI: 1.00–1.00, p<0.001)..

Conclusion: PVE from the right ventricle (V2) shows excellent diagnostic accuracy in differentiating AVNRT from AVRT..

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