Differentiate AVNRT from Orthodromic AVRT

NCT ID: NCT06671145

Last Updated: 2024-11-04

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 80 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-10-31
• Study Completion Date: 2027-09-10

Brief Summary

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).

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.

Conditions

SVT

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: DIAGNOSTIC
• Blinding Strategy: SINGLE

Study Groups

group (1)catheter ablation after diagnosis of Atrioventricular Nodal Reentry Tachycardia

diagnosis Atrioventricular Nodal Reentry Tachycardia before catheter ablation

Group Type: ACTIVE_COMPARATOR

catheter ablation

Intervention Type: DIAGNOSTIC_TEST

Catheter ablation after differentiating Atrioventricular Nodal Reentry Tachycardia from Orthodromic Atrioventricular Reentry Tachycardia during electrophysiological study.

group (2) catheter ablation after diagnosis of orthodromic Atrioventricular Reentry Tachycardia

diagnosis of orthodromic Atrioventricular Reentry Tachycardia before catheter ablation

Group Type: ACTIVE_COMPARATOR

catheter ablation

Intervention Type: DIAGNOSTIC_TEST

Catheter ablation after differentiating Atrioventricular Nodal Reentry Tachycardia from Orthodromic Atrioventricular Reentry Tachycardia during electrophysiological study.

Interventions

catheter ablation

Catheter ablation after differentiating Atrioventricular Nodal Reentry Tachycardia from Orthodromic Atrioventricular Reentry Tachycardia during electrophysiological study.

Intervention Type: DIAGNOSTIC_TEST

Eligibility Criteria

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 -

• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Assiut University

OTHER

Sponsor Role: lead

Responsible Party

Hossam El Din Mohamed Farghaly

doctor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Doaa Ahmed Fouad, pro

Role: PRINCIPAL_INVESTIGATOR

Assiut University

Heba Mahmoud Abdel Mohsen El- naggar, Ass. pro

Role: PRINCIPAL_INVESTIGATOR

Assiut University

marwan sayed mahmoud, doctor

Role: PRINCIPAL_INVESTIGATOR

Assiut University

Central Contacts

Hossam EL Din mohamed, Resident

Role: CONTACT

hossammo198@gmail.com

+20 01125970318 ext. +20 0112597031

Other Identifiers

AVNRT and orthodromic AVRT

Identifier Type: -

Identifier Source: org_study_id