scholarly journals Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

2016 ◽  
Vol 5 (2) ◽  
pp. 130 ◽  
Author(s):  
Demosthenes G Katritsis ◽  
Mark E Josephson ◽  
◽  
Keyword(s):  
Practical Significance ◽  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Common Pathway ◽  
Activation Patterns ◽  
Atrial Activation ◽  
Diagnostic Criterion ◽  
Fast Pathway

Atrioventricular nodal reentrant tachycardia (AVNRT) should be classified as typical or atypical. The term ‘fast-slow AVNRT’ is rather misleading. Retrograde atrial activation during tachycardia should not be relied upon as a diagnostic criterion. Both typical and atypical atrioventricular nodal reentrant tachycardia are compatible with varying retrograde atrial activation patterns. Attempts at establishing the presence of a ‘lower common pathway’ are probably of no practical significance. When the diagnosis of AVNRT is established, ablation should be only directed towards the anatomic position of the slow pathway. If right septal attempts are unsuccessful, the left septal side should be tried. Ablation targeting earliest atrial activation sites during typical atrioventricular nodal reentrant tachycardia or the fast pathway in general for any kind of typical or atypical atrioventricular nodal reentrant tachycardia, are not justified. In this review we discuss current concepts about the tachycardia circuit, electrophysiologic diagnosis, and ablation of this arrhythmia.

scholarly journals Superior-Type Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Phenotype Mimicking the Slow-Fast Type

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Yoshiaki Kaneko ◽  
Tadashi Nakajima ◽  
Shuntaro Tamura ◽  
Hiroshi Hasegawa ◽  
Takashi Kobari ◽  
...  
Keyword(s):  
Cycle Length ◽  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Common Pathway ◽  
His Bundle ◽  
Overdrive Pacing ◽  
Atrial Activation ◽  
The Right ◽  
Superior Type

Background: Superior-type fast-slow (sup-F/S-) atrioventricular nodal reentrant tachycardia (AVNRT) is a rare AVNRT variant using a superior slow pathway (SP) as the retrograde limb. Its intracardiac appearance, characterized by a short atrio-His (AH) interval and the earliest site of atrial activation in the His-bundle, is an initial indicator for making a diagnosis. Methods: Among 22 consecutive patients with sup-F/S-AVNRT, 3 (age, 68–81 years) patients had an apparent slow-fast (S/F-) AVNRT characterized by a long AH interval and the earliest site of atrial activation in or superior to the His-bundle region (tachy-long-AH). Results: The diagnosis of sup-F/S-AVNRT was based on the standard criteria in 2 patients and on the occurrence of Wenckebach-type atrioventricular block during tachycardia, which was attributable to a block at the lower common pathway (LCP) below the circuit of the AVNRT, detected owing to the lower common pathway potentials, in one patient. As with the typical S/F-AVNRT, tachy-long-AH was induced after a jump in the AH interval. In contrast to typical S/F-AVNRT, fluctuation in the ventriculoatrial interval was observed during the tachy-long-AH. Ventricular overdrive pacing was unable to entrain or terminate the tachy-long-AH. Moreover, the tachy-long-AH reciprocally transited to/from sup-F/S-AVNRT spontaneously or was triggered by ventricular contractions while the atrial cycle length and earliest site of atrial activation remained unchanged. Both tachycardias were cured by ablation at a single site in the right-side para-Hisian region of 2 patients and the noncoronary aortic cusp of one patient. Collectively, the essential circuit of both tachycardias was identical, and the tachy-long-AH was diagnosed as another phenotype of sup-F/S-AVNRT accompanied by sustained antegrade conduction via another bystander slow pathway breaking through the His-bundle owing to the repetitive antegrade block at the lower common pathway, thus representing a long AH interval during the ongoing sup-F/S-AVNRT. Conclusions: An unknown sup-F/S-AVNRT phenotype exists that apparently mimics the typical S/F-AVNRT and is also an unknown subtype of apparent S/F-AVNRT.

Abstract 2647: Analysis of the Anatomical and Electrophysiological Characteristics of Tachycardia Circuit in Atrioventricular Nodal Reentrant Tachycardia Accompanied by the Block in the Upper Common Pathway

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kenji Morihisa ◽  
Hiroshige Yamabe ◽  
Yasuaki Tanaka ◽  
Takashi Uemura ◽  
Hisao Ogawa
Keyword(s):  
Cycle Length ◽  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Common Pathway ◽  
Coronary Sinus Ostium ◽  
Coupling Interval ◽  
Atrial Electrogram ◽  
Sinus Ostium ◽  
Fast Pathway

We examined the anatomical and electrophysiological characteristic of the atrioventricular nodal reentrant tachycardia (AVNRT) accompanied by the ventriculo-atrial block during tachycardia, suggesting the presence of upper common pathway in 8 patients. Tachycardia was induced by the atrial burst and/or extrastimulation followed by the AH jump and the earliest atrial electrogram was observed at the His bundle (HB) site in all patients. The HA block was observed after gradual prolongation of the HA interval in 2 patient and abruptly in 6 patients. After administration of isoproterenol, 1:1 HA conduction was resumed in all patients. The tachycardia cycle length, AeHe interval and HeAe interval were 357±89, 275±55 and 80±44 msec, respectively. Single extrastimulus delivered from the HB site reset the tachycardia as soon as it was delivered during late diastole. However, single extrastimulus delivered from the inferior portion of the coronary sinus ostium (I-CSOS) was unable to reset the tachycardia without capturing the earliest atrial electrogram at the HB site, suggesting that atrium is not involved in the circuit. Thus, the longest coupling interval of single extrastimulus that reset the tachycardia at the HB site was significantly longer than that at I-CSOS (347±89 msec vs. 324±109 msec, p=0.012). The following return cycle after extrastimulation at the HB site did not differ from the tachycardia cycle length (357±89 msec, vs. 357±89 msec, p=NS), however, that at I-CSOS was significantly longer than the tachycardia cycle length (398±85 msec, vs. 357±89 msec, p=0.012). Catheter ablation was performed in a stepwise fashion starting at the inferior CSOS. Although the results of single extrastimulation showed that the atrial myocardium at I-CSOS was out of the reentry circuit, ablation near the I-CSOS, distant from HB site, selectively eliminated slow pathway conduction in all patients without impairment of fast pathway conduction. Conclusions: The AVNRT with upper common pathway has the characteristic of relatively long HA interval during tachycardia. Sub-atrial tissue, but not the atrium, extending from the HB site to I-CSOS forms the upper common pathway in AVNRT. It was shown that upper common pathway has an anatomical structure of a certain range.

scholarly journals Changes in electrophysiologic properties of the conductive system of the heart in children with atrioventricular nodal reentrant tachycardia after 2–8 years following radiofrequency catheter ablation of the slow pathway

Medicina ◽  
2009 ◽  
Vol 45 (8) ◽  
pp. 632 ◽  
Author(s):  
Rima Šileikienė ◽  
Dalia Bakšienė ◽  
Vytautas Šileikis ◽  
Tomas Kazakavičius ◽  
Jolanta Vaškelytė ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Refractory Period ◽  
Atrioventricular Node ◽  
Atropine Sulfate ◽  
Effective Refractory Period ◽  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Fast Pathway

Radiofrequency ablation of the slow pathway is an effective method of treatment in children with atrioventricular nodal reentrant tachycardia. The aim of our study was to evaluate anterograde conduction properties in children before and after radiofrequency ablation of the slow pathway and to determine the efficacy and safety of this method. Material and methods. Noninvasive transesophageal electrophysiological examination was performed in 30 patients at the follow-up period (mean duration, 3.24 years) after radiofrequency ablation of the slow pathway. Results. The slow pathway function was observed in 13 patients one day after ablation, in 26 patients during the follow-up period, and in 28 patients after administration of atropine sulfate. Atrioventricular node conduction was significantly decreased the following day after ablation and at the follow-up versus the preablation (165.2 [30.2] bmp and 146.3 [28.5] bpm versus 190.9 [31.4] bpm; P<0.001). The atrioventricular node effective refractory period prolonged significantly the following day after ablation and at the follow-up versus the preablation (319.3 [55.3] ms and 351.0 [82.1] ms versus 248.3 [36.6] ms; P<0.001). Effective refractory period of the fast pathway prolonged significantly as compared with the preablation (from 408.0 [60.4] ms to 481.2 [132.9] ms; P=0.005). The prolongation of effective refractory period of the slow pathway was more significant than effective refractory period of the fast pathway at the follow-up (P<0.001). Two late recurrences occurred; one patient had atrial tachycardia. Conclusion. Children with atrioventricular nodal reentrant tachycardia can be effectively and safety cured by ablative therapy. The end-point during slow pathway ablation should be the abolition of tachycardia with preservation of dual atrioventricular nodal physiology.

Effects of Slow Pathway Ablation on Fast Pathway Function in Patients with Atrioventricular Nodal Reentrant Tachycardia

1997 ◽  
Vol 8 (6) ◽  
pp. 627-638 ◽  
Author(s):  
WIN-KUANG SHEN ◽  
THOMAS M. MUNGER ◽  
MARSHALL S. STANTON ◽  
MICHAEL J. OSBORN ◽  
STEPHEN C. HAMMILL ◽  
...  
Keyword(s):  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Slow Pathway Ablation ◽  
Pathway Function ◽  
Fast Pathway

Atrioventricular Nodal Reentrant Tachycardia in Children: Effect of Slow Pathway Ablation on Fast Pathway Function

2002 ◽  
Vol 13 (3) ◽  
pp. 203-209 ◽  
Author(s):  
GEORGE F. HARE ◽  
NANCY A. CHIESA ◽  
ROBERT M. CAMPBELL ◽  
RONALD J. KANTER ◽  
FRANK CECCHIN ◽  
...  
Keyword(s):  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Slow Pathway Ablation ◽  
Pathway Function ◽  
Fast Pathway

Abstract 1541: Atypical Atrioventricular Nodal Reentrant Tachycardia with Anterior Retrograde Slow Pathway: Incidence, Electrophysiological Characteristics and Effect of Slow Pathway Ablation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kiyoshi Otomo ◽  
Yasutoshi Nagata ◽  
Hiroshi Taniguchi ◽  
Kikuya Uno ◽  
Yoshito Iesaka
Keyword(s):  
Anterior Part ◽  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Av Block ◽  
Ventricular Pacing ◽  
Reentrant Tachycardia ◽  
Slow Pathway Ablation ◽  
Atrial Activation ◽  
The Right ◽  
Second Degree

BACKGROUND: Atypical AV nodal reentrant tachycardias (AVNRT) usually exhibit earliest retrograde atrial activation (ERAA) at the right posteroseptum (Rt-PS) or proximal coronary sinus (PCS). However, previous studies have shown that atypical AVNRT could rarely exhibit ERAA at the right anteroseptum (Rt-AS). The purpose of this study was to elucidate the incidence, characteristics and effect of slow pathway (SP) ablation in atypical AVNRT with an anterior retrograde SP. METHODS: The electrophysiological and ablation data were reviewed in 360 AVNRTs induced in 340 consecutive patients. Atypical AVNRT was differentiated from typical form by a longer H-A interval during ventricular pacing at the tachycardia cycle length (TCL) (HAp: =/>70ms), and evidences for a lower common pathway (LCP), including second-degree AV block without tachycardia interruption, HAp longer than the HA interval during tachycardia (HAt). Atypical AVNRTs were classified into two types; the posterior type with ERAA at the Rt-PS or PCS; and anterior type with ERAA at the Rt-AS. RESULTS: In a total of 360 AVNRTs, there were 300 typical (83%) and 60 atypical forms (17%). Among the 60 atypical forms, 51 (14%) were classified into the posterior type, while the remaining 9 (3%) were classified into the anterior type. The anterior type of atypical AVNRT (TCL: 322+/−37ms) exhibited ERAA at the Rt-AS during the tachycardia and ventricular pacing, shorter A-H interval (162+/−39ms), longer HAt (167+/−40 ms), longer HAp (184+/−53ms), and evidences for a LCP, including a second-degree AV block during the tachycardia (n=4) and HAt being shorter than the H-Ap (n=9). All posterior types of atypical AVNRT were rendered non-inducible after an ablation to the ERAA site. In anterior type, the conventional SP ablation at the Rt-PS did not eliminate any of the 9 tachycardias; however, ablations at the right midseptum eliminated 7 (78%) of the 9 anterior types of atypical AVNRT. CONCLUSION: Atypical AVNRT with an anterior retrograde SP was observed in 3% of all AVNRTs. Conventional Rt-PS ablation was ineffective; and the midseptal ablation was modestly effective in this entity. The tachycardia circuit of the anterior type might be deviated to more anterior part of the Koch’s triangle than that of the posterior type.

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