P1010Electrophysiological characteristics of paroxysmal tachycardia in children with short PQ interval

Abstract Introduction It is well known that children with short PQ interval can have different types paroxysmal tachycardia (PT). Combination of short PQ interval with PT is called Lown-Ganong-Levine (LGL) syndrome. We have hypothesized that in children with short PQ interval electrophysiological types of PT do not correlate with shortening of PQ interval. Purpose The aim of the study was to assess the PT types based on results of the electrophysiological studies and radiofrequencycatheter ablation (RFA), and to estimate the AV conduction parameters and their dynamic changes before and after the procedure. Materials and methods of research: 55 children with supraventricular tachycardia (SVT) and short PQ interval were examined. The examination included:ECG, 24-hour Holter monitor, transesophageal pacing study (TEPS), intracardiac electrophysiological study (EPS). 22 children underwent RFA procedure. During the period of the study 55 children had 111 TEPS and 28 EPS studies. Results 21 (38,2%) children had orthodromic AV reentrant tachycardia with accessory pathway (AVRT), 27 (49,1%) had typical (slow-fast) AV nodal reentrant tachycardia (AVNRT), 2 (3,6%) had atypical AVNRT, 1 (1,8%) had combination of typical and atypical AVNRT, 1 (1,8%) had atrial ectopic tachycardia combined with atypical AVNRT, 4 (7,3%) had spontaneous atrial fibrillation or atrial flutter, 3 (5,4%) had combination with typical AVNRT and 1 child (1,8%) had AVRT. PQ interval measured 107,2 ms (83–120ms). 22 (40%) children underwent RFA-13 children with typical AVNRT, 9 with AVRT. In children with AVNRT tachycardia cycle length was 229–425 ms (309,8±67,6ms). Primary RFA was effective in 10 (76,9%) children. The AVNRT recurrence was found in 3 (13,6%) cases after 7,2±4,3 month from the time of procedure. After slow pathway ablation PQ interval length didn't change (107,1±9,1ms compared to 108,2±7,1ms; p=0,2). No change occurred with the maximal rate of 1:1 conduction through AV node (187,8±14,8 imp/min compared to187±12,5 imp/min; p=0,2). Effective refractory period of AV node (AVNERP) increased by a small amount (288,9±14ms, compared to 266±42,7ms; p=0,06). 9 (40,9%) children underwent RFA of the accessory pathway (AP). In all of the cases there were concealed AP with the left-sided localization. AVRT cycle length was 259–382 ms (304,2±41,2ms). After RFA of concealed AP maximal rate of 1:1 conduction through AV node increased by a small amount (220±26,4 imp/min compared to 191,2±23,6 imp/min) and AVNERP decreased (256,7±25,2ms compared to 268,6±38,9ms; p=0,09).After RFA of AP PQ interval length didn't change (110±5,9ms compared to 110±5ms; p=0,1). Conclusion In children with short PQ interval PT was associated with dual physiology of AV connection or with concealed AP. After the successful RFA in children with AVNRT and AVRT there was no PQ interval normalization, which remained short in all examinations. Thus, short PQ- interval is a co-existing phenomenon in children with AVNRT and AVRT.

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Evidence for functionally distinct dual atrial inputs to the human AV node

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1994.267.6.h2333 ◽

1994 ◽

Vol 267 (6) ◽

pp. H2333-H2341 ◽

Cited By ~ 3

Author(s):

K. M. Stein ◽

B. B. Lerman

Keyword(s):

Radiofrequency Ablation ◽

Coronary Sinus ◽

Cycle Length ◽

Animal Studies ◽

Accessory Pathway ◽

Interatrial Septum ◽

Slow Pathway ◽

Av Node ◽

Crista Terminalis

Although conventional models of the human atrioventricular (AV) node assume a single upper common pathway, animal studies demonstrate dual atrial inputs: an anterior input from the interatrial septum and a posterior input from the crista terminalis (running near the os of the coronary sinus in the posteroseptal region). We hypothesized that functionally distinct dual atrial inputs to the AV node also exist in humans and that the anterior input has a lower safety factor for impulse propagation. To evaluate this hypothesis, we examined 20 patients undergoing radiofrequency ablation of the slow AV nodal pathway for AV nodal reentrant tachycardia who underwent subsequent follow-up testing. After ablation near the os of the coronary sinus (and posterior to the compact AV node), 11 patients had no residual slow pathway conduction [SP(-)], whereas 9 did [SP(+)]. The effective refractory period of the fast AV nodal pathway (FP-ERP) and anterograde AV nodal Wenckebach (AVN-W) cycle length were significantly increased at follow-up in the SP(-) patients (FP-ERP = 336 +/- 71 vs. 387 +/- 103 ms, P = 0.02; AVN-W cycle length = 356 +/- 74 vs. 442 +/- 118 ms, P = 0.03) but not in SP(+) patients. Similarly among 10 patients undergoing radiofrequency ablation of a right posteroseptal accessory pathway (near the os of the coronary sinus), 5 developed impaired AV conduction: abnormal anterograde pacing-induced AVN-W cycle length in 4 patients and 2:1 AV nodal block in 1 patient.(ABSTRACT TRUNCATED AT 250 WORDS)

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Abstract 5678: Fast-Fast Form of Atypical AV Nodal Reentrant Tachycardia: Incidence, Electrophysiological Characteristics and Results of Catheter Ablation

Circulation ◽

10.1161/circ.118.suppl_18.s_982-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Kiyoshi Otomo ◽

Yasutoshi Nagata ◽

Hiroshi Tachiguchi ◽

Kikuya Uno ◽

Hideomi Fujiwara ◽

...

Keyword(s):

Electrophysiological Study ◽

Slow Pathway ◽

Av Block ◽

Reentrant Tachycardia ◽

Rare Form ◽

Av Nodal Reentrant Tachycardia ◽

Atrial Activation ◽

The Right ◽

Fast Pathway ◽

Activation Sequence

Both the typical (slow-fast (S/F)) and atypical (slow-slow (S/S) and fast-slow (F/S)) forms of the AV nodal reentrant tachycardias (AVNRT) are usually amenable to the classical slow pathway (SP) ablation at the inferoseptal atrial region. However, rare cases of unusual forms AVNRT do not involve an SP in the tachycardia circuits (TC), and they are resistant to the classical SP ablation. The characteristics of the atypical AVNRTs not involving an SP in the TCs remain to be elucidated. A total of 1252 AVNRTs induced during the electrophysiological study in 950 cases were analyzed. Both the anterograde and retrograde limbs of the TC were classified into the fast pathway (FP) or SP according to the A-H (AHI) and H-A intervals (HAI) during the tachycardia; the anterograde FP: AHI of <220 ms, anterograde SP: AHI of ≥220 ms, retrograde FP: HAI of <120 ms, and retrograde SP: HAI of ≥120 ms. Accordingly, each tachycardia was classified into one of the S/F, S/S, F/S and fast-fast (F / F) forms . There were 998 S/F forms (79.7%), 119 S/S forms (9.5%), 129 F/S forms (10.3%) and 6 F / F forms (0.5%). The F / F forms were induced by atrial or ventricular extrastimulation without an associated jump-up in the AHI and HAI, and they were characterized by a shorter tachycardia cycle length (260±55 ms), short AHI (153±39 ms) and HAI (107±19 ms) during the tachycardia, earliest retrograde atrial activation (ERAA) at the right superoseptum (n=2) or midseptum (n=4), and 2nd degree AV block without a tachycardia interruption. The retrograde atrial activation sequence during the F / F forms was identical to that during ventricular pacing. The tachycardias could be entrained from the RV, and they resumed with a V-A-V sequence after the cessation of the entrainment pacing. The classical SP ablation at the right inferoseptal region was unsuccessful in all 6 cases with the F / F forms . The successful ablation was achieved at the right superoseptum (n=2) or midseptum (n=4) without creating AV block in all 6 cases. The F / F forms of atypical AVNRT not involving a classical SP in the TC were observed in 0.5% of all AVNRT cases. The results of this study suggested that the TC was smaller and confined to the superior part of the AV nodal area in this extremely rare form of AVNRT.

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Anatomical versus electrophysiological approaches for ablation of the slow pathway in patients with AV nodal reentrant tachycardia

Cardiac Pacing and Electrophysiology ◽

10.1007/978-94-011-0872-0_16 ◽

1994 ◽

pp. 145-154

Author(s):

Michel Haissaguerre ◽

Bruno Fischer ◽

Philippe Le Métayer ◽

Pierre Jais ◽

Philippe Egloff ◽

...

Keyword(s):

Slow Pathway ◽

Reentrant Tachycardia ◽

Av Nodal Reentrant Tachycardia

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Anatomically guided surgery to the AV node *1AV nodal skeletonization: experience in 46 patients with AV nodal reentrant tachycardia

European Journal of Cardio-Thoracic Surgery ◽

10.1016/1010-7940(90)90166-w ◽

1990 ◽

Vol 4 (9) ◽

pp. 461-465 ◽

Cited By ~ 12

Author(s):

G GUIRAUDON ◽

G KLEIN ◽

N VANHEMEL ◽

C GUIRAUDON ◽

R YEE ◽

...

Keyword(s):

Reentrant Tachycardia ◽

Av Node ◽

Guided Surgery ◽

Av Nodal Reentrant Tachycardia

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Clinical recurrence of palpitations following slow pathway ablation in patients with suspected paroxysmal supraventricular tachycardias but non-documented, non-inducible tachycardias

EP Europace ◽

10.1093/europace/euab116.078 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

J Ramos Jimenez ◽

A Marco Del Castillo ◽

VC Lozano Granero ◽

C Lazaro Rivera ◽

R Salgado ◽

...

Keyword(s):

Catheter Ablation ◽

Electrophysiological Study ◽

Accessory Pathway ◽

Clinical Suspicion ◽

Therapeutic Modality ◽

P Value ◽

Slow Pathway ◽

Clinical Recurrence ◽

Slow Pathway Ablation ◽

Supraventricular Tachycardias

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablation is recommended as first-line treatment in patients with atrioventricular nodal reentry tachycardias (AVNRT). However, the best therapeutic modality in patients with dual AV nodal physiology but non-inducible tachycardias in electrophysiological study (EPS) remains controversial, especially when no tachycardias have been documented. Our objective was to evaluate the results of empirical slow pathway ablation in patients showing dual AV nodal physiology but non-inducible AVNRT. Methods Multicenter, retrospective, observational registry of consecutive patients undergoing EPS due to clinical suspicion of paroxysmal supraventricular tachycardias (PSVT), but with no prior ECG documentation. Clinical, EPS and ablation (when performed) data were collected and andalyzed. Results 427 patients of 12 centers were included. Mean age was 46.3 ±16.1 and 297 (69.6%) were females. AVNRT was induced in 188 patients (typical in 181 cases, atypical in 7). Dual AV nodal physiology with or without single nodal echo beats, but with no sustained tachycardia and without evidence of accessory pathway was present in 68 patients. Ablation of the slow pathway was performed in 187/188 patients with AVNRT and in 30/68 patients with dual physiology. Among subjects with non-inducible tachycardia, ablation reduced significantly recurrences (39.5% in non-ablated vs. 16.7%; p = 0.04), with a level equivalent to those with ablated AVNRT(14.4% vs. 16.7%; p = 0.75). Procedure-related complications were similar in both groups: empirical ablation n = 1; 3.3% vs. induced tachycardia n = 6; 3.2% (p = 0.98). Conclusions In patients with high clinical suspicion of PSVT but non-documented and non-inducible arrhythmias, the presence of dual AV nodal physiology makes AVNRT a likely mechanism of the clinical tachycardia. Catheter ablation of slow pathway reduces the risk of recurrence to a level equivalent to those with inducible and ablated AVNRT. AVNRT (n = 188) Dual nodal physiology (n = 68) p value Age (years) 48.6 ± 16.3 41.9 ± 14.0 <0.01 Female 71.8% 67.7% 0.52 Years symptomatic 9.3 ± 11.3 3.6 ± 8.1 <0.01 Sudden onset 83.9% 88.0% 0.54 Abrupt end 73.4% 74.6% 0.96 Previous rate-slowing drugs 30.9% 25.0% 0.36 Previous antiarrhythmic drugs 5.9% 2.9% 0.35 Isoproterenol in EPS 70.0% 89.7% <0.01

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