(FIT)-Module 2 Workshop 2: Entrainment and SVT Maneuvers-Miller Workshop 2

Miller Workshop 2

Pdf Summary

This document is a summary of a workshop conducted by Dr. John M. Miller, a professor of medicine at Indiana University School of Medicine. The workshop focuses on the interpretation of tracings from electrophysiologic studies for the diagnosis of supraventricular tachycardia (SVT). The workshop includes four questions with corresponding tracings and answer explanations.<br /><br />In the first question, a 58-year-old woman with occasional SVT undergoes an electrophysiologic study. The results of ventricular overdrive pacing during SVT indicate an apparent VAAV with ventricular pacing, suggesting atrial tachycardia, but further analysis reveals that it is actually a pseudo-VAAV (actual VAV) with intervals indicating atrioventricular nodal reentry (AVNRT).<br /><br />The second question involves a 25-year-old man with recurrent SVT. Stimulation results show an atrial activation sequence suggesting a left-sided accessory pathway, but atrial tachycardia or atypical AVNRT are also possibilities.<br /><br />The third question features a 57-year-old man who underwent thoracoscopic maze surgery for atrial fibrillation. Overdrive pacing from a Halo electrode during an EP study shows an unanticipated pause and a subsequent reversal of the wave front, indicating that the pacing site is in a diastolic corridor of a reentrant AT.<br /><br />In the fourth question, a 45-year-old man with wide QRS tachycardia undergoes an EP study. The effect of an extrastimulus shows a PAC during wide QRS tachycardia, which suggests simple antidromic tachycardia.<br /><br />The workshop emphasizes the use of stimulation during tachycardia to differentiate one type of SVT from another, determine tachycardia mechanism, and identify potential ablation sites. However, careful consideration is needed when interpreting the effects of stimulation and ensuring that capture is present for accurate conclusions.<br /><br />Overall, the workshop provides valuable insights into the interpretation of tracings from electrophysiologic studies for the diagnosis of SVT.

Keywords

supraventricular tachycardia

electrophysiologic study

atrial tachycardia

atrioventricular nodal reentry

ventricular overdrive pacing

accessory pathway

atrioventricular nodal reentry tachycardia

thoracoscopic maze surgery

wide QRS tachycardia

antidromic tachycardia