A practical criterion for the rapid detection of single-loop and double-loop reentry tachycardias

Nick W F Linton, Stephen B Wilton, Daniel Scherr, Ashok J Shah, Nicolas Derval, Frederic Sacher, Matthew Wright, Mélèze Hocini, Mark D O'Neill, Michel Haïssaguerre, Pierre Jaïs

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Entrainment criteria for the diagnosis of reentrant atrial tachycardia can be difficult to apply and cannot detect double-loop reentry. We sought to develop and clinically test a new criterion for the diagnosis of single- and double-loop reentry.

Methods and Results
(1) Proposed criterion: after sequential overdrive pacing at 2 different locations and assessing the first ensuing beats of tachycardia, the difference in activation time recorded between 2 appropriate stationary positions changes by 1 or 2 tachycardia cycle lengths; a change of 2 tachycardia cycle lengths usually indicates double-loop reentry rather than only a single-loop. (2) Clinical testing: multiple overdrive pacing maneuvers were undertaken and analyzed in 5 patients with common flutter (single-loop reentry). In total, 23 pairs of overdrive pacing maneuvers were performed using electrodes in the coronary sinus and a distribution of positions in the right atrium. In 22/23 pairs of maneuvers, the change in Activation Difference was within 2.6 ± 12.4 milliseconds of the tachycardia cycle length, confirming single loop reentry. For double-loop reentry, the literature was reviewed and 3 cases of double-loop reentry were identified with sufficient data. In all of these cases, double-loop reentry was detected and also the zone containing the common isthmus was identified.

The proposed criterion can diagnose single- and double-loop reentry atrial tachycardia using intracardiac recordings from any pair of well separated positions. The criterion does not require precise electrode placement or extensive activation mapping.
Original languageEnglish
Article numberN/A
Pages (from-to)544-52
Number of pages9
JournalJournal of Cardiovascular Electrophysiology
Issue number5
Publication statusPublished - May 2013


  • Atrial Flutter
  • Electrocardiography
  • Humans
  • Mathematics
  • Models, Theoretical
  • Tachycardia, Atrioventricular Nodal Reentry


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