Differentiate AVNRT from Orthodromic AVRT

Study of New Simple Maneuvers for Differentiating Atrioventricular Nodal Reentry Tachycardia from Orthodromic Atrioventricular Reentry Tachycardia During Electrophysiological Study

To study new maneuvers to differentiate AVNRT from orthodromic AVRT including VA interval variability at tachycardia induction, SA-VA base and local VA index (difference between local VA interval, measured on the coronary sinus catheter during tachycardia and entrainment, at the site of earliest atrial activity).

Study Overview

• Status: Not yet recruiting
• Conditions: SVT
• Intervention / Treatment: Diagnostic test: catheter ablation

Detailed Description

The differentiation of atrioventricular nodal reentrant tachycardia (AVNRT) from atrioventricular reciprocating tachycardia (AVRT) as well as the localization of accessory pathways (APs) is necessary to guide the catheter ablation of supraventricular tachycardia (SVT). However, existing techniques may prove challenging in differentiating atypical forms of AVNRT from AVRT using a septal AP; or localizing AVRT with different septal AP insertion sites.

There are many diagnostic maneuvers during electrophysiological study eg ventriculo atrial interval (VA) during tachycardia, postpacing interval tachycardia cycle length (PPI-TCL) and stimulus atrial ventriculaoatrial interval (SA-VA). It is important to recognize that as with most diagnostic tests, no single observation or maneuver is 100% sensitive or specific. Therefore, it is important to obtain data from multiple observations and maneuvers to verify the diagnosis.

Also, utility of these techniques usually depends on the tachycardia to be sustained, however sometimes tachycardia is rapidly terminating. VA interval at initiation of tachycardia is usually variable and becomes fixed after several beats. This may be explained by differences in retrograde conduction between AVRT and AVNRT which may be better exposed at the time of tachycardia induction, So measuring the number of beats until VA becomes fixed may theoretically help in differentiating AVNRT from AVRT.

Although several reports have demonstrated the usefulness of the SA-VA using right ventricular (RV) apical stimulation (SA-VAapex) to distinguish AVNRT from AVRT, there remains significant overlap in the SA-VA complicating the distinction between these 2 arrhythmias.

Theoretically, stimulation from the RV basal septum (SA-VAbase) would be expected to shorten the SA interval in AVRT because atrioventricular pathways insert in the ventricular base. On the other hand, the SA-VAbase should have the opposite effect on AVNRT because the impulse must first pass from the RV base to the apex to access the right bundle.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Hossam EL Din mohamed, Resident; Phone Number: +20 0112597031 +20 01125970318; Email: hossammo198@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• All patients with documented narrow complex supraventricular tachycardia presented to electrophysiology lab including all age and sex patients (in Assiut university cath. lab) and proved to be AVNRT or orthodromic AVRT.

Exclusion Criteria:

1. Atrial tachycardia
2. Atrial flutter.
3. Atrial fibrillation.
4. Manifest preexcitation on surface ECG -

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: group (1)catheter ablation after diagnosis of Atrioventricular Nodal Reentry Tachycardia; diagnosis Atrioventricular Nodal Reentry Tachycardia before catheter ablation	Diagnostic test: catheter ablation; Catheter ablation after differentiating Atrioventricular Nodal Reentry Tachycardia from Orthodromic Atrioventricular Reentry Tachycardia during electrophysiological study.
Active Comparator: group (2) catheter ablation after diagnosis of orthodromic Atrioventricular Reentry Tachycardia; diagnosis of orthodromic Atrioventricular Reentry Tachycardia before catheter ablation	Diagnostic test: catheter ablation; Catheter ablation after differentiating Atrioventricular Nodal Reentry Tachycardia from Orthodromic Atrioventricular Reentry Tachycardia during electrophysiological study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
To differentiate between narrow complex supraventricular tachycardia (AVNRT from orthodromic AVRT during electrothysiological study).	24 months

Collaborators and Investigators

• Sponsor: Assiut University
• Investigators: Principal Investigator: Doaa Ahmed Fouad, pro, Assiut university; Principal Investigator: Heba Mahmoud Abdel Mohsen El- naggar, Ass. pro, Assiut university; Principal Investigator: marwan sayed mahmoud, doctor, Assiut university

Study record dates

Study Major Dates

• Study Start (Estimated): October 31, 2024
• Primary Completion (Estimated): September 10, 2026
• Study Completion (Estimated): September 10, 2027

Study Registration Dates

• First Submitted: October 20, 2024
• First Submitted That Met QC Criteria: October 31, 2024
• First Posted (Estimated): November 4, 2024

Study Record Updates

• Last Update Posted (Estimated): November 4, 2024
• Last Update Submitted That Met QC Criteria: October 31, 2024
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Keywords: AVNRT - orthodromic AVRT
• Other Study ID Numbers: AVNRT and orthodromic AVRT

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No