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Ozcan EE, Turan OE, Akdemir B, Inevi UD, Yilancioglu RY, Baskurt AA, Alak C, Bayrak F. Comparison of electrophysiological characteristics of right- and left-sided Mahaim-type accessory pathways. J Cardiovasc Electrophysiol 2021; 32:360-369. [PMID: 33355963 DOI: 10.1111/jce.14852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/26/2020] [Accepted: 12/13/2020] [Indexed: 12/01/2022]
Abstract
AIMS Mahaim-type accessory pathways (MAPs) are generally right-sided due to the embryological differentiation, but left-sided localization is also possible. This study aims to compare the clinical and electrophysiological characteristics of right- and left-sided MAPs. METHODS Of 251 patients diagnosed with AP by electrophysiological study between November 2015 and February 2020, 12 patients with MAP were included (right sided n = 8, left sided n = 4). MAP was diagnosed if; (1) no retrograde conduction; (2) anterograde decremental conduction; (3) adenosine sensitivity; and (4) Mahaim potential at successful ablation site were present. RESULTS Ten of twelve MAPs were clustered on the lateral walls of the mitral (n = 3, 75%) and tricuspid annuli (n = 7, 87.5%). Right-sided MAPs were mostly long pathways extending toward the conduction system whereas left-sided MAPs were short extending toward the neighboring myocardium. For right- and left-sided APs, the median QRS times were 129 and 156 ms (p = .042), the median VAbl -RVApex intervals were -12 and 64 ms (p = .007), the median QRS-V(His) intervals were 16 and 86 ms (p = .120), and the median VAbl -QRS interval was -8 and 12 ms (p = .017), respectively. Coexistence of dual atrioventricular node physiology was observed only in right-sided APs (n = 3, 37.5%). CONCLUSION MAPs are more typically located on the right but may rarely be seen on the left. Catheter ablation was associated with high success without complications.
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Affiliation(s)
- Emin Evren Ozcan
- Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Oguzhan Ekrem Turan
- Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Baris Akdemir
- Department of Cardiology, Faculty of Medicine, Goztepe Medicalpark Hospital, Bahcesehir University, Istanbul, Turkey
| | | | | | - Ahmet Anil Baskurt
- Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Cetin Alak
- Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Fatih Bayrak
- Department of Cardiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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2
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Prolic Kalinsek T, Pernat A, Sinkovec M, Jan M. Treatment of left-sided extension of AV node: A valuable integration of advance imaging modalities and cryoablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1605-1608. [PMID: 32681524 DOI: 10.1111/pace.14015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/20/2020] [Accepted: 07/12/2020] [Indexed: 12/01/2022]
Abstract
We present a case of successful cryoablation of the left extension of the atrioventricular (AV) node for treatment of a recurrent atrioventricular nodal reentry tachycardia without the use of fluoroscopy. Three-dimensional electroanatomic mapping system and intracardiac echocardiography were used to navigate catheters in the heart and position them according to anatomical landmarks. Due to the nature of cryoablation lesion formation, lesions were able to be applied safely in right atrium, as well as in left atrium, without damaging AV node or bundle of His.
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Affiliation(s)
- Tine Prolic Kalinsek
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrej Pernat
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matjaz Sinkovec
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matevz Jan
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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3
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Shelton R, Cho JH, Joshi S, Betzold R, Shehata M, Ehdaie A, Swerdlow C. Treatment of atypical pacemaker-mediated tachycardia with ablation of the retrograde atrioventricular nodal pathway. J Cardiovasc Electrophysiol 2020; 31:1213-1217. [PMID: 32108404 DOI: 10.1111/jce.14424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 12/01/2022]
Abstract
A 25-year-old runner received a single-lead, VDD pacemaker after ablation of AV nodal reentrant tachycardia complicated by intermittent AV block. The rate-adaptive AV delay algorithm (RAAV), which shortens the sensed AV interval (SAV) at faster atrial rates, was programmed to provide a physiologic SAV with exercise. She developed repetitive, atypical, long-RP pacemaker-mediated tachycardia (PMT) because the RAAV shortened the antegrade SAV and retrograde conduction occurred over the slow AV nodal pathway. PMT was refractory to usual programming solutions. Using high-density electroanatomic mapping, we were able to ablate the retrograde limb of PMT without further damaging AV conduction.
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Affiliation(s)
- Richard Shelton
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jae H Cho
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Michael Shehata
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ashkan Ehdaie
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Charles Swerdlow
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Romero J, Kumar S, Akira F, Briceño DF, Tedrow UB, Epstein L, John R, Stevenson WG, Michaud GF. Emergence of atrioventricular nodal reentry tachycardia after surgical or catheter ablation for atrial fibrillation: Are we creating the arrhythmia substrate? Heart Rhythm 2017; 14:1637-1646. [DOI: 10.1016/j.hrthm.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 11/25/2022]
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Efimova E, Riahi S, Fiedler L, Esato M, Sommer P, Richter S, Breithardt O, Rolf S, Bollmann A, Hindricks G, Arya A. Adenosine sensitivity of retrograde fast pathway conduction in patients with slow-fast atrioventricular nodal reentrant tachycardia: A prospective study. Heart Rhythm 2014; 11:871-6. [DOI: 10.1016/j.hrthm.2014.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Indexed: 10/25/2022]
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6
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Ardashev AV, Makarenko AS, Zhelyakov EG, Shavarov AA. Atrioventricular nodal reentrant tachycardia treatment using novel potential. Asian Cardiovasc Thorac Ann 2010; 18:529-35. [PMID: 21149400 DOI: 10.1177/0218492310387852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radiofrequency ablation of atrioventricular nodal reentrant tachycardia is commonly guided by slow and sharp bipolar potentials of the atrioventricular slow nodal pathway. We optimized the morphology of the guiding potential by unipolar mapping of the slow nodal pathway. We identified a novel unipolar dual-component atrial electrogram at the anterior limb of the coronary sinus ostium. The first component was a positive delta-wave type that corresponded to the isoelectric phase on a bipolar electrogram. The second component had fast biphasic morphology and corresponded to the R wave on a bipolar atrial electrogram. Of 104 consecutive patients with typical atrioventricular nodal reentrant tachycardia, 51 were treated with ablation guided by the novel potential, and 53 underwent ablation using the conventional technique. There was no recurrence of tachycardia in any of these patients. In those treated by the novel potential, there was significantly less radiofrequency power applied and a shorter duration of application than in patients treated by the traditional approach. The novel approach to mapping and ablation of the slow nodal pathway in atrioventricular nodal reentrant tachycardia guided by unipolar recording was safe and effective, and comparable to the traditional technique.
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Affiliation(s)
- Andrey V Ardashev
- Clinical Hospital of Federal Biomedical Agency of Russia, Moscow, Russia.
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7
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Multiple forms of atypical atrioventricular nodal reentrant tachycardia with different right- and left-sided retrograde slow pathways. J Cardiol Cases 2010; 2:e111-e114. [DOI: 10.1016/j.jccase.2010.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 05/07/2010] [Accepted: 05/13/2010] [Indexed: 11/17/2022] Open
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Sághy L, Makai A, Bencsik G, Pap R. Coexistent right- and left-sided slow pathways participating in distinct AV nodal reentrant tachycardias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1348-50. [PMID: 18811819 DOI: 10.1111/j.1540-8159.2008.01189.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a patient with two distinct atrioventricular (AV) nodal slow pathways, participating in two different AV nodal reentrant tachycardias--one eliminated from the right, the other only after ablation on the left side of the posterior septum. The case provides support for the concept of the posterior AV nodal extensions--a biatrial structure in most hearts--representing the anatomic basis of slow pathway conduction.
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Affiliation(s)
- László Sághy
- Second Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
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Katritsis DG, Papagiannis J. Anatomically left-sided septal slow pathway ablation in dextrocardia and situs inversus totalis. Europace 2008; 10:1004-5. [DOI: 10.1093/europace/eun163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Katritsis DG, Becker A. The atrioventricular nodal reentrant tachycardia circuit: A proposal. Heart Rhythm 2007; 4:1354-60. [PMID: 17905343 DOI: 10.1016/j.hrthm.2007.05.026] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Accepted: 05/24/2007] [Indexed: 11/17/2022]
Abstract
Several models of the atrioventricular nodal reentrant tachycardia circuit have been proposed. Recently, there has been experimental and clinical electrophysiology evidence that the right and left inferior extensions of the human atriventricular node and the atrionodal inputs they facilitate may provide the anatomic substrate of the slow pathway. Inferior nodal extensions appear to constitute a necessary limb of the tachycardia circuit in all forms of atrioventricular nodal reentrant tachycardia and represent the ablation target for all forms of this arrhythmia. Anatomic variations of multiple atrionodal inputs via atrial transitional cells may create the conditions for tachycardia inducibility and differing patterns of retrograde atrial activation. In the present article, we summarize the available evidence and propose a comprehensive model of the tachycardia circuit for all forms of atrioventricular nodal reentrant tachycardia based on the concept of atrionodal inputs.
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Katritsis DG, Ellenbogen KA, Becker AE, Camm AJ. Retrograde slow pathway conduction in patients with atrioventricular nodal re-entrant tachycardia. ACTA ACUST UNITED AC 2007; 9:458-65. [PMID: 17478461 DOI: 10.1093/europace/eum067] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To study retrograde slow pathway conduction by means of right- and left-sided septal mapping. METHODS AND RESULTS Nineteen patients with slow-fast atrioventricular nodal re-entrant tachycardia (AVNRT) were studied before and after slow pathway ablation. Simultaneous His bundle recordings from right and left sides of the septum, using trans-aortic and trans-septal electrodes, were made during right ventricular pacing. Pre-ablation, decremental retrograde ventriculo-atrial (VA) conduction without jumps or discontinuities was recorded in eight patients (group 1). In six patients, retrograde conduction jumps were demonstrated (group 2) and in the remaining four patients, there was minimal prolongation of stimulus to atrium (St-A) intervals (group 3). The maximal difference (Delta St-A) between St-A intervals obtained with pacing at a constant cycle length of 500 ms and at the cycle length with maximal retrograde VA prolongation was significantly longer measured from the right His compared with the left His (122 +/- 25 vs. 110 +/- 33 ms, P = 0.02, respectively) in group 1 and group 2 (140 +/- 23 vs. 110 +/- 35 ms, P = 0.03), but not in group 3 (10 +/- 4 vs. 13 +/- 8 ms, P = 0.35). Post-ablation, Delta St-A intervals were similar between right and left His recordings (77 +/- 37 vs. 76 +/- 33 ms, P = 0.53, respectively) in group 1, (100 +/- 24 vs. 103 +/- 21 ms, P = 0.35) group 2, and (63 +/- 32 vs. 66 +/- 33 ms, P = 0.35) group 3. CONCLUSION In patients with typical AVNRT, retrograde conduction through the slow pathway results in earliest retrograde atrial activation on the left side of the septum and catheter ablation in the right inferoparaseptal area abolishes this pattern. These findings are compatible with the concept of slow pathway conduction by means of the inferior AV nodal extensions.
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Valderrábano M. Atypical atrioventricular nodal reentry with eccentric atrial activation. Is the right target on the left? Heart Rhythm 2007; 4:433-4. [PMID: 17399628 DOI: 10.1016/j.hrthm.2007.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Indexed: 11/30/2022]
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13
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Khairy P, Mercier LA, Dore A, Dubuc M. Partial atrioventricular canal defect with inverted atrioventricular nodal input into an inferiorly displaced atrioventricular node. Heart Rhythm 2007; 4:355-8. [PMID: 17341403 DOI: 10.1016/j.hrthm.2006.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 10/06/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Montreal, Quebec, Canada.
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15
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Katritsis DG, Ellenbogen KA, Becker AE. Atrial activation during atrioventricular nodal reentrant tachycardia: Studies on retrograde fast pathway conduction. Heart Rhythm 2006; 3:993-1000. [PMID: 16945788 DOI: 10.1016/j.hrthm.2006.05.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Accepted: 05/30/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Detailed right and left septal mapping of retrograde atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) has not been undertaken and may provide insight into the complex physiology of AVNRT, especially the anatomic localization of the fast and slow pathways. OBJECTIVES The purpose of this study was to investigate the pattern of retrograde atrial activation during typical AVNRT by means of right-sided and left-sided septal mapping and implementation of pacing maneuvers for separating atrial and ventricular electrograms recorded during tachycardia. METHODS Twenty-two patients with slow-fast AVNRT were studied by means of simultaneous His-bundle recordings from the right and left sides of the septum. Patterns of retrograde atrial activation were recorded during tachycardia following specific pacing maneuvers and during right ventricular apical (RVA) pacing at the tachycardia cycle length. RESULTS The pattern of retrograde atrial activation could be mapped in 17 of 22 patients during AVNRT. In 9 (53%) patients, the earliest retrograde atrial activation was recorded on the left side of the septum, in 3 (17%) patients on the right side, and in 5 (29%) patients both right and left atrial septal electrograms occurred simultaneously. Stimulus to atrial electrogram times recorded during RVA pacing in 14 patients were 138.5 ms from the right His bundle, 134.5 ms from the left His bundle, and 148.0 ms from the ostium of the coronary sinus (P <.001). The predominant site of earliest retrograde atrial activation during RVA pacing was the left side of the septum (10 patients [71%]). Only 8 (57%) of 14 patients demonstrated concordance in the pattern of retrograde atrial activation during AVNRT and RVA pacing. CONCLUSION Earliest retrograde atrial activation during AVNRT is most often recorded on the left side of the septum. Breakthrough of atrial activation may be discordant from that observed during RVA pacing.
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Katritsis DG, Becker AE, Ellenbogen KA, Giazitzoglou E, Korovesis S, Camm AJ. Effect of slow pathway ablation in atrioventricular nodal reentrant tachycardia on the electrophysiologic characteristics of the inferior atrial inputs to the human atrioventricular node. Am J Cardiol 2006; 97:860-5. [PMID: 16516590 DOI: 10.1016/j.amjcard.2005.09.135] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Revised: 09/23/2005] [Accepted: 09/23/2005] [Indexed: 10/25/2022]
Abstract
The inferior atrial extensions of the atrioventricular (AV) node have been related to the anatomic substrate of the slow pathway, but their role in AV nodal reentrant tachycardia (AVNRT) is unknown. Ten patients with slow-fast AVNRT were studied before and after successful slow pathway ablation. Simultaneous His bundle recordings from the right and left sides of the septum were made during right and left inferoparaseptal pacing. Longer stimulus to His (St-H) intervals were measured during right inferoparaseptal pacing than during left inferoparaseptal pacing (284 +/- 55 vs 246 +/- 46 ms, p = 0.005 for right His recordings and 283 +/- 56 vs 244 +/- 46 ms, p = 0.005 for left His recordings) at similar coupling intervals during AVNRT induction. After ablation, the St-H intervals at the maximum AV nodal conduction decrement were similar during right inferoparaseptal and left inferoparaseptal pacing (217 +/- 32 vs 207 +/- 21 ms, p = 0.10 for right His and 215 +/- 32 vs 206 +/- 20 ms, p = 0.13 for left His) at similar coupling intervals. The difference (DeltaSt-H) between St-H intervals during AVRNT induction or at the maximum conduction decrement and during constant pacing for right His recordings with right inferoparaseptal pacing were significantly greater than DeltaSt-H measured with left His during left inferoparaseptal pacing (173 +/- 64 vs 137 +/- 55 ms, p = 0.005) before ablation, but not after (117 +/- 39 vs 100 +/- 40 ms, p = 0.44). Resetting of AVNRT with delivery of left inferoparaseptal extrastimuli was achieved in 7 of 10 patients. In conclusion, the electrophysiologic characteristics of the right and left inferior atrial inputs to the human AV node in patients with AVNRT and their response to slow pathway ablation provide further evidence that the inferior nodal extensions represent the anatomic substrate of the slow pathway.
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Katritsis DG, Camm AJ. Classification and differential diagnosis of atrioventricular nodal re-entrant tachycardia. ACTA ACUST UNITED AC 2006; 8:29-36. [PMID: 16627405 DOI: 10.1093/europace/euj010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Recent evidence on atrioventricular nodal re-entrant tachycardia has identified several types of this common arrhythmia, with potential therapeutic implications. This article reviews the relevant new information, discusses the differential diagnosis of atrioventricular nodal re-entrant tachycardia, and summarizes the electrophysiological criteria for classification of the various forms of the arrhythmia.
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Katritsis DG, Ellenbogen KA. Eccentric retrograde atrial activation in atrioventricular nodal reentrant tachycardia. Heart Rhythm 2005; 2:1394-5; author reply 1395. [PMID: 16360102 DOI: 10.1016/j.hrthm.2005.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2005] [Indexed: 11/16/2022]
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