VAAV response

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V-A-A-V Response

During SVT if you perform the Ventricular Overdrive Maneuver which is pacing at a Cycle Length 10 to 60 msec shorter than the tachycardia Cycle Length until 1:1 VA conduction. Once you stop pacing if you look at the reponse you will see a VAV response or a VAAV (VAAH) response which indicates Atrial Tachycardia

Pseudo V-A-A-V response

A pseudo VAAV response can occur when performing the Ventricular Overdrive Maneuver in patients with a long HV interval.(See Figure Below) This is why is important to include the His deflection in your tracings. In the figure below, the Ventricular Overdrive Maneuver resulted in a VAAHV response. This response can be seen in

  1. AVNRT and AVRT when the baseline HV interval is prolonged (as in this case) or
  2. When VOD pacing results in a VA on the slow pathway and the first A after termination of ventricular pacing is from the second to last ventricular paced beat.

This patient presented to the hospital with a wide complex tachycardia with the same morphology as the baseline sinus rhythm EKG. Measurement of baseline intervals revealed a prolonged HV interval.
This patient presented to the hospital with a wide complex tachycardia with the same morphology as the baseline sinus rhythm EKG. Measurement of baseline intervals revealed a prolonged HV interval.
VAAHV response
VAAHV response
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