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Halder A, Vijay S, Kolamkar Y, Kumble YM, Lokhandwala Y. Clinical profile and electrophysiological characteristics of atypical atrioventricular nodal reentrant tachycardia: A decade's experience. Indian Pacing Electrophysiol J 2024; 24:25-29. [PMID: 37839730 PMCID: PMC10928009 DOI: 10.1016/j.ipej.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE To assess the clinical features and inducibility characteristics of atypical atrioventricular nodal reentrant tachycardia (AVNRT) and compare it with typical AVNRT. BACKGROUND AVNRT is the commonest form of paroxysmal supraventricular tachycardia. The mechanism of AVNRT is very varied. Several classification systems evolved with better understanding but a simplified approach of classification into typical and atypical AVNRT is justifiable and clinically more relevant. In our study, we have assessed the epidemiological profile of atypical AVNRT in a single institute over 10 years and analysed pertinent electrophysiological characteristics. METHOD In this retrospective observational single center study we analysed data of all AVNRT cases from January 2011 to June 2021. In our study we classified atypical AVNRT and typical AVNRT based on the HA interval; HA≤70 ms in the His bundle region during tachycardia was considered as typical AVNRT. Other parameters were also analysed during tachycardia, such as: induction by atrial or ventricular pacing, AH/HA ratio, tachycardia cycle length and site of the earliest atrial activation. The demographic profile of the patients were also compared between 2 groups. RESULTS Atypical AVNRT was found in 75/1431 patients (5.2%) of all cases of AVNRT. The age of patients with atypical AVNRT was 52.4 ± 15.2 years (range 9-82 years) while that for typical AVNRT it was 48.2 ± 15.7 years (2-89 years), p = 0.023. There was no gender difference. Atypical AVNRT was induced by only ventricular extrastimuli (VES) in 17/75 (22.6%) while in typical AVNRT this was seen in only 12/1356 patients (0.9%, p < 0.001). Induction of atypical AVNRT was seen by both atrial extrastimuli (AES) and VES in 17/75 patients (22.6%) while in typical AVNRT this was seen in 64/1356 patients (4.8%, p < 0.001). Atypical AVNRT was induced by only AES in 40/75 patients (53.3%) while in typical AVNRT this was seen in 1280/1356 patients (94.3%, p < 0.001). An AH >200 ms during tachycardia was seen in all patients with typical AVNRT and in only 31/75 patients (41.3%) of atypical AVNRT (p < 0.00001). An interesting finding in atypical AVNRT was the earliest atrial activation at the His bundle region in 10/75 (13.3%) patients. CONCLUSION Atypical AVNRT prevalence depends on the way it is classified; this was 5.2% of all AVNRT cases in our study. Typical AVNRT was seen more frequently in comparatively younger age group and was more often induced by AES. Atypical AVNRT was much more commonly induced by only VES compared to typical AVNRT. It was not so unusual in atypical AVNRT to find the earliest atrial activation in the His bundle region.
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Affiliation(s)
- Ashesh Halder
- Department of Cardiology Medica Superspecialty Hospital, Kolkata, India.
| | | | - Yogesh Kolamkar
- Department of Cardiology, Holy Family Hospital, Mumbai, India
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Aslani A, Shahrzad S, Bazrafshan M, Rahmanian M, Fakhar R, Pirahesh K, Bazrafshan H, Bazrafshan H. Optimal method for ablation of atypical AVNRT. BMC Cardiovasc Disord 2023; 23:264. [PMID: 37208638 DOI: 10.1186/s12872-023-03305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Considering that ablation of atypical AVNRT may be unsuccessful after ablation at the right posterior septum, in this study, we aimed to present an optimal method for ablation of atypical AVNRT. Also, we evaluated the efficacy of this technique for preventing recurrences. METHODS This is a prospective, double-center study. It was conducted on 62 patients with atypical AVNRT referred for radiofrequency ablation. The patients were randomly divided into two groups before ablation: 1-Group A (n = 30): treated with conventional ablation at the anatomic area of the slow pathway; 2-Group B (n = 32): ablation was done 2 mm higher in the septum during fluoroscopy. RESULTS The mean age of patients in groups A and B were 54 ± 11.7 and 55 ± 12.2, respectively (P = 0.43). In group A, ablation was successful in 24 (80%) patients following right-sided slow pathway ablation, and the remaining patients required further treatment with either a left-side approach (N = 4, 13.3%) or ablation of additional regions (N = 2, 6.7%). In group B, ablation was successful in all patients. After a 48-month follow-up, recurrence of symptomatic atypical AVNRT was detected in 4 (13.3%) patients of group A and none of group B patients (p < 0.001). CONCLUSION In patients with atypical AVNRT, ablation 2 mm above the conventional area is more promising regarding success rate and recurrence of the arrhythmia.
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Affiliation(s)
- Amir Aslani
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehdi Bazrafshan
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Rahmanian
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Fakhar
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hanieh Bazrafshan
- Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran.
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Asvestas D, Tzeis S, Letsas K, Goga C, Efremidis M, Vardas P. Intra-atrial Conduction Block During Radiofrequency Ablation of Left-sided Accessory Pathways. J Innov Card Rhythm Manag 2022; 13:4884-4888. [PMID: 35251757 PMCID: PMC8887933 DOI: 10.19102/icrm.2022.130205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 08/17/2021] [Indexed: 12/05/2022] Open
Abstract
Catheter ablation is currently the therapeutic approach of choice for many patients with accessory pathways. Despite the high success rate of radiofrequency ablation of the left lateral accessory pathways, a rather uncommon manifestation is intra-atrial conduction block at the level of the mitral isthmus. We report 2 cases of orthodromic atrioventricular reentrant tachycardia using a concealed left-sided accessory pathway with an abrupt change in the activation of the coronary sinus from an eccentric to concentric sequence after ablation delivery. The electrophysiological characteristics and the underlying mechanism of the intra-atrial conduction block are commented on. Careful mapping and assessment of relative conduction are helpful to document the diagnosis of intra-atrial conduction block. Familiarity with the likelihood of intra-atrial block during left lateral accessory pathway ablation is needed to avoid the erroneous elucidation that a second accessory pathway is present and to identify correctly the ablation site of interest.
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Affiliation(s)
- Dimitrios Asvestas
- Cardiology Department, Mitera General Hospital, Hygeia Group, Athens, Greece
| | - Stylianos Tzeis
- Cardiology Department, Mitera General Hospital, Hygeia Group, Athens, Greece
| | - Konstantinos Letsas
- Second Department of Cardiology, Laboratory of Invasive Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Christina Goga
- Cardiology Department, Mitera General Hospital, Hygeia Group, Athens, Greece
| | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Invasive Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Panos Vardas
- Cardiology Department, Mitera General Hospital, Hygeia Group, Athens, Greece
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Kaneko Y, Nakajima T, Tamura S, Hasegawa H, Kobari T, Ishii H. Pacing site- and rate-dependent shortening of retrograde conduction time over the slow pathway after atrial entrainment of fast-slow atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol 2021; 32:2979-2986. [PMID: 34535933 PMCID: PMC9293002 DOI: 10.1111/jce.15242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
Introduction We tested our hypothesis that atrial entrainment pacing (EP) of a) the common‐type (com‐) fast‐slow (F/S‐) atypical atrioventricular nodal reentrant tachycardia (AVNRT) using a typical slow pathway (SP), or b) the superior‐type (sup‐) F/S‐AVNRT using a superior SP, both modify the retrograde conduction time across the SP immediately after termination of EP (retro‐SP‐time). Methods We measured the difference in the His‐atrial interval (HA difference) immediately after cessation of EP, performed at 2 ± 2 rates from the high right atrium (HA[1]‐HRA) versus from the proximal coronary sinus (HA[1]‐CS) in 17 patients with com‐F/S‐AVNRT and 11 patients with sup‐F/S‐AVNRT. We also measured the atrial‐His and HA intervals of the first and second cycles immediately after cessation of EP and during stable tachycardia. Results Unequal responses, defined as a ≥ 20‐ms HA difference at ≥1 EP rates, were observed in 16 patients (57%), including 7 with com‐ and 9 with sup‐F/S‐AVNRT. Irrespective of the EP rate, all unequal responses of com‐F/S‐AVNRT were due to a shorter HA[1]‐CS than HA[1]‐HRA, with a mean 34 ± 11 ms HA difference, whereas all unequal responses of sup‐F/S‐AVNRT were due to a longer HA[1]‐CS than HA[1]‐HRA, with a mean 49 ± 25 ms HA difference. The unequal responses resolved within two cycles after the cessation of EP. Conclusions We have identified a little‐known pacing site‐ and pacing rate‐dependent shortening of the retro‐SP‐time.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 518] [Impact Index Per Article: 172.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Kupó P, Tutuianu CI, Kaninski G, Gingl Z, Sághy L, Pap R. Limitations of ventricular pacing maneuvers to differentiate orthodromic reciprocating tachycardia from atrioventricular nodal reentry tachycardia. J Interv Card Electrophysiol 2021; 63:323-331. [PMID: 33871788 DOI: 10.1007/s10840-021-00993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Various ventricular pacing maneuvers have been developed to differentiate orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentry tachycardia (AVNRT). We aimed to evaluate the diagnostic value of ventricular pacing maneuvers in patients undergoing catheter ablation for AVNRT/ORT. METHODS Sixty patients with supraventricular tachycardia (SVT) undergoing invasive EP study were included (ORT: 31, typical AVNRT: 18, atypical AVNRT: 11). Ventricular overdrive pacing (VOP) and resetting by premature ventricular stimulation (PVS) during SVT were analyzed by 3 independent observers blinded to the ultimate diagnosis. We determined intraclass correlation coefficient (ICC) for interobserver agreement and the diagnostic accuracy of consensual results. RESULTS Although specificity of all parameters was high (96-100%) for ORT, semi-quantitative parameters of VOP (requiring the recognition of specific ECG patterns) had lower interobserver reliability (ICC: 0.32-0.66) and sensitivity (16.1-77.4%). In contrast, most quantitative measurements of VOP and PVS showed good reproducibility (ICC: 0.93-0.95) and sensitivity (74.2-89.3%), but post-pacing interval after VOP needed correction with AV nodal conduction slowing. False negative results for diagnosing ORT were more common with left free wall vs. right free wall or septal, and slowly vs. fast-conducting septal APs. False positivity was only seen with a bystander, concealed nodo-fascicular/nodo-ventricular (NF/NV) AP in a case of AVNRT. CONCLUSIONS No single maneuver is 100% sensitive for ORT. Semi-quantitative features have limited reproducibility and all parameters can be misleading in the case of rate-dependent delay during VOP/PVS, ORT circuits remote from the pacing site, or a bystander, concealed NF/NV AP.
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Affiliation(s)
- Péter Kupó
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary.
| | - Cristina Ioana Tutuianu
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - Genadi Kaninski
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - Zoltán Gingl
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - László Sághy
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - Róbert Pap
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
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Ali H, De Ambroggi G, Lupo P, Foresti S, De Lucia C, Turturiello D, Paganini EM, Cappato R. Recurrent unsustained long RP tachycardia: What is the mechanism? J Cardiovasc Electrophysiol 2021; 32:1195-1198. [PMID: 33600030 DOI: 10.1111/jce.14956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Hussam Ali
- Arrhythmia and Electrophysiology Center, IRCCS MultiMedica Group, Milan, Italy
| | - Guido De Ambroggi
- Arrhythmia and Electrophysiology Center, IRCCS MultiMedica Group, Milan, Italy
| | - Pierpaolo Lupo
- Arrhythmia and Electrophysiology Center, IRCCS MultiMedica Group, Milan, Italy
| | - Sara Foresti
- Arrhythmia and Electrophysiology Center, IRCCS MultiMedica Group, Milan, Italy
| | - Carmine De Lucia
- Arrhythmia and Electrophysiology Center, IRCCS MultiMedica Group, Milan, Italy
| | - Dario Turturiello
- Arrhythmia and Electrophysiology Center, IRCCS MultiMedica Group, Milan, Italy
| | | | - Riccardo Cappato
- Arrhythmia and Electrophysiology Center, IRCCS MultiMedica Group, Milan, Italy
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Left sided ablation for Atrioventricular Nodal Re-entrant Tachycardia: Frequency, Characteristics and Outcomes. Indian Pacing Electrophysiol J 2020; 21:5-10. [PMID: 33129971 PMCID: PMC7854377 DOI: 10.1016/j.ipej.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/04/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background Left-sided ablation, targeting left inferior AV nodal extensions, is thought to be necessary for success in a small proportion of atrioventricular nodal re-entrant tachycardia (AVNRT) ablations; however Indian data are scarce in this regard. Methods Consecutive cases of AVNRT undergoing slow pathway ablation in a single centre over an 18-month period were retrospectively analyzed. Left-sided ablation at the posteroseptal mitral annulus was performed if right-sided ablation failed to abolish AVNRT. Results From January 2017 to June 2018, out of 215 consecutive supraventricular tachycardia (SVT) cases, 154 (71.6%) were AVNRT (47.1 ± 13.1 years, 46.1% male). Trans-septal ablation was required in 5 (3.2%) cases (mean age 48.8 ± 9.4 years; 4 female, 1 male); all with typical (slow-fast) form of AVNRT. Compared with cases needing only right-sided ablation, radiofrequency time (50.8 ± 16.9 vs. 9.9 ± 8.5 min; p = 0.005) and procedure time (166.0 ± 35.0 vs 79.6 ± 35.9 min; p = 0.004) were significantly longer for trans-septal cases, while baseline intervals and tachycardia cycle length were not significantly different. Junctional ectopy was seen in only 2 of the 5 cases during left-sided ablation, but acute success (non-inducibility) was obtained in 3 cases. There were no instances of AV block. Over mean follow-up of 12.2 ± 4.0 months, clinical recurrence of AVNRT occurred in one case, while others remained arrhythmia-free without medication. Conclusion Left-sided ablation was required in a small proportion of AVNRT ablations. Trans-septal approach targeting the posteroseptal mitral annulus was safe and yielded good mid-term clinical success.
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Katritsis DG. A unified theory for the circuit of atrioventricular nodal re-entrant tachycardia. Europace 2020; 22:1763-1767. [DOI: 10.1093/europace/euaa196] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/17/2020] [Indexed: 01/04/2023] Open
Abstract
Abstract
Atrioventricular nodal re-entrant tachycardia (AVNRT) is the most common regular tachycardia in the human, but its exact circuit remains elusive. In this article, recent evidence about the electrophysiological characteristics of AVNRT and new data on the anatomy of the atrioventricular node, are discussed. Based on this information, a novel, unified theory for the nature of the circuit of the tachycardia is presented.
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Tamura S, Nakajima T, Iizuka T, Hasegawa H, Kobari T, Kurabayashi M, Kaneko Y. Unique electrophysiological properties of fast‐slow atrioventricular nodal reentrant tachycardia characterized by a shortening of retrograde conduction time via a slow pathway manifested during atrial induction. J Cardiovasc Electrophysiol 2020; 31:1420-1429. [DOI: 10.1111/jce.14501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/29/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Shuntaro Tamura
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Tadashi Nakajima
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Takashi Iizuka
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Takashi Kobari
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Yoshiaki Kaneko
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
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Okada M, Tanaka K, Matsunaga-Lee Y, Ninomiya Y, Hirao Y, Oka T, Tanaka N, Inoue H, Iwakura K, Fujii K, Inoue K. Multiple Shifts of the Earliest Retrograde Atrial Activation Site Along the Tricuspid Annulus During the Fast-Slow Form of Atrioventricular Nodal Reentrant Tachycardia by Radiofrequency Modification. Int Heart J 2019; 60:761-767. [PMID: 31105149 DOI: 10.1536/ihj.18-406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 70-year-old woman was admitted for treatment of supraventricular tachycardia. Ventriculoatrial conduction was revealed through programmed ventricular stimulation; the coronary sinus ostium (CSos) was the earliest atrial activation site. The fast-slow forms of atrioventricular nodal reentrant tachycardia (AVNRT) were induced by ventricular extra-stimuli. During tachycardia, the earliest atrial activation site was located at the bottom of CSos. Radiofrequency (RF) energy application to this site resulted in the delay of local electrical potential, prolongation of tachycardia cycle length, and a shift of the earliest retrograde activation site to the roof of CSos. Subsequent ablation induced a similar shift to the inferior tricuspid annulus and to the right posterior septum. Finally, RF energy application to the right posterior septum resulted in the termination of tachycardia, which was not induced afterward. Multiple shifts in the earliest retrograde atrial activation site along the tricuspid annulus after each slow pathway ablation suggested that annular tissue plays a substantial role as a substrate for AVNRT.
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Affiliation(s)
- Masato Okada
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Yasuharu Matsunaga-Lee
- Department of Cardiology, Japan Community Healthcare Organization (JCHO) Hoshigaoka Medical Center
| | | | - Yuko Hirao
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Takafumi Oka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | | | | | | | - Kenshi Fujii
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
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Varvarousis D, Polytarchou K, Margos P, Psychari SN, Paravolidakis K, Tsoukalas D, Kotsakis A. Supraventricular tachycardia with QRS and cycle length alternans. What is the diagnosis? Hellenic J Cardiol 2019; 60:331-333. [PMID: 30682421 DOI: 10.1016/j.hjc.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/03/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Dimitrios Varvarousis
- 2(nd) Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece.
| | - Kali Polytarchou
- 1(st) Department of Cardiology, Evagelismos General Hospital of Athens, Ipsilantou 45-47, 10676, Athens, Greece
| | - Panagiotis Margos
- 1(st) Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Stavroula N Psychari
- 2(nd) Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Konstantinos Paravolidakis
- 2(nd) Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Dionysios Tsoukalas
- 2(nd) Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Athanasios Kotsakis
- 2(nd) Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
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Nakashima T, Takasugi N, Sahashi Y, Kubota T, Kawasaki M. Shift in the retrograde atrial activation sequence after radiofrequency catheter ablation in left variant atypical atrioventricular nodal reentrant tachycardia. J Electrocardiol 2018; 52:63-65. [PMID: 30476641 DOI: 10.1016/j.jelectrocard.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
The role of left AV nodal (SVN) connections in the genesis of "left-variant" atypical atrioventricular nodal reentrant tachycardia (AVNRT) and those with multiple retrograde pathways remain unclear. We describe an unusual case of "left-variant" atypical AVNRT, where change in the retrograde earliest atrial activation site (REAAS) at the coronary sinus (CS) following radiofrequency catheter ablation (RFCA) was observed. Our observation suggests that the REAAS, that is, the left AVN connections, could participate in the formation of the reentrant circuit of "left-variant" atypical AVNRT. Furthermore, its atrial breakthroughs involved as a circuit of SVT could be (functionally) multiple.
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Affiliation(s)
- Takashi Nakashima
- Department of Cardiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Nobuhiro Takasugi
- Department of Cardiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Yuki Sahashi
- Department of Cardiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Tomoki Kubota
- Department of Cardiology, Gifu Municipal Hospital, 1-7 Kashimacho, Gifu 500-8513, Japan
| | - Masanori Kawasaki
- Department of Cardiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
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15
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Oesterle A, Marcus GM. Termination of tachycardia with resolution of left bundle branch block: What is the mechanism? HeartRhythm Case Rep 2018; 4:434-436. [PMID: 30228972 PMCID: PMC6140618 DOI: 10.1016/j.hrcr.2018.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Gregory M. Marcus
- Address reprint requests and correspondence: Dr Gregory M. Marcus, Section of Electrophysiology, Division of Cardiology, University of California, San Francisco, 500 Parnassus, MUE 434, San Francisco, CA 94143.
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16
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Markowitz SM, Lerman BB. A contemporary view of atrioventricular nodal physiology. J Interv Card Electrophysiol 2018; 52:271-279. [DOI: 10.1007/s10840-018-0392-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/31/2018] [Indexed: 11/30/2022]
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17
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Affiliation(s)
- Karen M. Marzlin
- Karen M. Marzlin is Cardiology APRN, Aultman Hospital, Canton, Ohio, and Business Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, 4565 Venus Rd, Uniontown, OH 44685
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18
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Liu CF, Ip JE, Cheung JW, Thomas G, Markowitz SM, Lerman BB. Utility of Pre-Induction Ventriculoatrial Response to Adenosine in the Diagnosis of Orthodromic Reciprocating Tachycardia. JACC Clin Electrophysiol 2017; 3:266-275. [DOI: 10.1016/j.jacep.2016.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/09/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
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19
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Bagga S, Padanilam BJ, Prystowsky EN. Eccentric Atrial Activation During a Narrow QRS Tachycardia: What Is the Mechanism? J Cardiovasc Electrophysiol 2016; 27:1353-1355. [PMID: 27489050 DOI: 10.1111/jce.13060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/01/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Shiv Bagga
- St. Vincent Medical Group, Cardiac Electrophysiology, Indianapolis, Indiana, USA
| | - Benzy J Padanilam
- St. Vincent Medical Group, Cardiac Electrophysiology, Indianapolis, Indiana, USA
| | - Eric N Prystowsky
- St. Vincent Medical Group, Cardiac Electrophysiology, Indianapolis, Indiana, USA
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20
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Katritsis DG, Josephson ME. Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia. Arrhythm Electrophysiol Rev 2016; 5:130-5. [PMID: 27617092 DOI: 10.15420/aer.2016.18.2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
| | - Mark E Josephson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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21
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Green J, Aziz Z, Nayak HM, Upadhyay GA, Moss JD, Tung R. "Left ventricular" AV nodal reentrant tachycardia: Case report and review of the literature. HeartRhythm Case Rep 2016; 2:367-371. [PMID: 28491712 PMCID: PMC5419939 DOI: 10.1016/j.hrcr.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
| | | | | | | | | | - Roderick Tung
- Center for Arrhythmia Care | Heart and Vascular Center, The University of Chicago Medicine, Chicago, Illinois
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22
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Kim D, Lee MY. Spontaneous Transition of Double Tachycardias with Atrial Fusion in a Patient with Wolff-Parkinson-White Syndrome. Korean Circ J 2016; 46:574-9. [PMID: 27482269 PMCID: PMC4965439 DOI: 10.4070/kcj.2016.46.4.574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/03/2016] [Accepted: 03/24/2016] [Indexed: 11/20/2022] Open
Abstract
Among patients with Wolff-Parkinson-White syndrome, atrioventricular reciprocating tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) can coexist in a single patient. Direct transition of both tachycardias is rare; however, it can occur after premature atrial or ventricular activity if the cycle lengths of the two tachycardias are similar. Furthermore, persistent atrial activation by an accessory pathway (AP) located outside of the AV node during ongoing AVNRT is also rare. This article describes a case of uncommon atrial activation by an AP during AVNRT and gradual transition of the two supraventricular tachycardias without any preceding atrial or ventricular activity in a patient with preexcitation syndrome.
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Affiliation(s)
- Dongmin Kim
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Dankook University, Cheonan, Korea
| | - Myung-Yong Lee
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Dankook University, Cheonan, Korea
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23
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Katritsis DG, Sepahpour A, Marine JE, Katritsis GD, Tanawuttiwat T, Calkins H, Rowland E, Josephson ME. Atypical atrioventricular nodal reentrant tachycardia: prevalence, electrophysiologic characteristics, and tachycardia circuit. Europace 2015; 17:1099-106. [DOI: 10.1093/europace/euu387] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/03/2014] [Indexed: 11/12/2022] Open
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24
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Nakatani Y, Mizumaki K, Nishida K, Sakamoto T, Yamaguchi Y, Kataoka N, Sakabe M, Fujiki A, Inoue H. Electrophysiological and anatomical differences of the slow pathway between the fast-slow form and slow-slow form of atrioventricular nodal reentrant tachycardia. Europace 2013; 16:551-7. [DOI: 10.1093/europace/eut253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Katritsis DG, Josephson ME. Classification of electrophysiological types of atrioventricular nodal re-entrant tachycardia: a reappraisal. ACTA ACUST UNITED AC 2013; 15:1231-40. [DOI: 10.1093/europace/eut100] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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26
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Von Bergen NH, Law IH. AV nodal reentrant tachycardia in children: Current approaches to management. PROGRESS IN PEDIATRIC CARDIOLOGY 2013. [DOI: 10.1016/j.ppedcard.2012.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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27
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Vaseghi M, Fujimura O, Shivkumar K. Narrow QRS complex tachycardia: what is the mechanism? Heart Rhythm 2012; 10:1402-4. [PMID: 22885663 DOI: 10.1016/j.hrthm.2012.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine, UCLA, Los Angeles, California 90095-1679, USA.
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28
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VEENHUYZEN GEORGED, QUINN FRUSSELL, WILTON STEPHENB, CLEGG ROBIN, MITCHELL LBRENT. Diagnostic Pacing Maneuvers for Supraventricular Tachycardias: Part 2. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:757-69. [DOI: 10.1111/j.1540-8159.2012.03352.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Nayyar S, Arora V, Nair M. A supraventricular tachycardia with two atrial activation sequences: What is the mechanism? Heart Rhythm 2011; 8:1299-301. [DOI: 10.1016/j.hrthm.2010.09.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Indexed: 11/27/2022]
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30
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Ablation of atrioventricular nodal reentrant tachycardia in the elderly: results from the German Ablation Registry. Heart Rhythm 2011; 8:981-7. [DOI: 10.1016/j.hrthm.2011.02.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 02/03/2011] [Indexed: 11/23/2022]
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31
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32
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Arias MA, Puchol A, Castellanos E, Rodríguez-Padial L. Right ventricular entrainment of a narrow QRS complex tachycardia: What is the mechanism? Heart Rhythm 2010; 7:1154-6. [DOI: 10.1016/j.hrthm.2009.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Indexed: 10/20/2022]
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33
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Johnson C, Scheinman M. Supraventricular Tachycardia: Where to Ablate? Card Electrophysiol Clin 2010; 2:217-220. [PMID: 28770753 DOI: 10.1016/j.ccep.2010.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article presents a case of typical atrioventricular nodal reentrant tachycardia with eccentric atrial activation where the successful ablation site was within the coronary sinus. Although most typical atrioventricular nodal reentrant tachycardia, regardless of site of earliest retrograde activation, can be modified by traditional right-sided slow pathway modification, it is important to remember that ablation of left posterior nodal extensions within the coronary sinus or over the mitral annulus may afford the key to termination of tachycardia when standard approaches fail.
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Affiliation(s)
- Colleen Johnson
- Division of Cardiology, Department of Cardiac Electrophysiology, University of California San Francisco, 500 Parnassus Avenue, MU 434, Box 1354, San Francisco, CA 94143, USA
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34
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CANO OSCAR, OSCA JOAQUÍN, SANCHO-TELLO MARÍAJOSÉ, OLAGÜE JOSÉ. Apparent AV Dissociation upon Induction of a Narrow Complex Tachycardia. What Is the Mechanism? Pacing Clin Electrophysiol 2010; 33:482-5. [DOI: 10.1111/j.1540-8159.2009.02656.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Affiliation(s)
- Frank C. Chen
- From the Department of Medicine (F.C.C., S.J.A.), Division of Cardiovascular Diseases, and Department of Pediatric and Adolescent Medicine (S.J.A.), Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn
| | - Samuel J. Asirvatham
- From the Department of Medicine (F.C.C., S.J.A.), Division of Cardiovascular Diseases, and Department of Pediatric and Adolescent Medicine (S.J.A.), Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn
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36
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Bhakta H, Wang X, Gupta N, Ji S. One tachycardia with two entrainment responses: what is the mechanism? Heart Rhythm 2009; 7:136-7. [PMID: 19884047 DOI: 10.1016/j.hrthm.2008.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 12/18/2008] [Indexed: 12/13/2022]
Abstract
The patient presented for electrophysiology study and ablation for a history of narrow complex tachycardia. Both typical and atypical atrioventricular nodal reentrant tachycardia (AVNRT) were induced. For the atypical AVNRT, two different entrainment responses were recorded owing to different timing in delivering the ventricular pacing train.
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Affiliation(s)
- Hetal Bhakta
- Division of Cardiac Electrophysiology, Southern California Permanente Medical Group, Los Angeles, CA, USA
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37
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Arias MA, Puchol A, Castellanos E, Rodríguez-Padial L. A narrow QRS complex tachycardia with eccentric retrograde atrial activation sequence: what is the mechanism? J Cardiovasc Electrophysiol 2009; 20:1410-2. [PMID: 19656245 DOI: 10.1111/j.1540-8167.2009.01569.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Miguel A Arias
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de Salud, Toledo, Spain
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38
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DIVAKARA MENON SYAMKUMARM, HEALEY JEFFS, NAIR GIRISHM, RIBAS CARLOSS, BARANCHUK ADRIAN, NERY PABLOB, SUMNER GLENL, CONNOLLY STUARTJ, MORILLO CARLOSA. A Case of Long-RP Tachycardia: What is the Mechanism? J Cardiovasc Electrophysiol 2009; 20:702-4. [DOI: 10.1111/j.1540-8167.2008.01423.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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39
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Atrioventricular node anatomy and physiology: implications for ablation of atrioventricular nodal reentrant tachycardia. Curr Opin Cardiol 2009; 24:105-12. [DOI: 10.1097/hco.0b013e328323d83f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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41
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Matsushita T, Ishida S, Oketani N, Ichiki H, Ninomiya Y, Hamasaki S, Tei C. A technique for diagnosis of accessory pathway using the H-H and A-A intervals of the first entrained cycle during ventricular overdrive pacing. Am J Cardiol 2008; 102:197-202. [PMID: 18602521 DOI: 10.1016/j.amjcard.2008.03.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 03/04/2008] [Accepted: 03/04/2008] [Indexed: 11/25/2022]
Abstract
Although advancement of succeeding atrial activation by a ventricular extrastimulus (VES) on His refractoriness during supraventricular tachycardia (SVT) has been used as evidence of an accessory pathway (AP), the sensitivity of this method is suboptimal. This study was designed to compare the His-His (H-H) and atrial-atrial (A-A) intervals of the first entrained cycle during ventricular overdrive pacing (VOD) for the diagnosis of AP, in comparison to the conventional VES method. In 55 patients with SVT, a VES was elicited on His refractoriness during SVT. VOD was subsequently performed at cycle lengths 30 to 40 ms shorter than SVT cycle lengths. When the A-A interval became equal to the pacing cycle length after some beats of VOD, the cycle was considered the first entrained cycle and the H-H interval preceding the A-A interval was measured. VES advanced the next atrial activation in 16 patients (52%) with an AP, but in no patient without an AP. The H-H interval of the first entrained cycle was longer than the pacing cycle length by > or =15 ms in all patients with an AP, but was equal to the pacing cycle length in all patients without an AP. The criterion of H-H greater than A-A by > or =15 ms for the first entrained cycle provided higher diagnostic yield for AP compared with the VES method(100% vs 52%, p <0.001). In conclusion, this new criterion reliably diagnoses the presence of an AP in patients with SVT, with higher sensitivity compared with the VES method.
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Differentiating atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia by ΔHA values during entrainment from the ventricle. Heart Rhythm 2008; 5:83-8. [DOI: 10.1016/j.hrthm.2007.09.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 09/15/2007] [Indexed: 11/22/2022]
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43
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Irregular atypical atrioventricular nodal reentrant tachycardia: Incidence, electrophysiological characteristics, and effects of slow pathway ablation. Heart Rhythm 2007; 4:1507-22. [DOI: 10.1016/j.hrthm.2007.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 08/10/2007] [Indexed: 11/18/2022]
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44
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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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45
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Ong MGY, Lee PC, Tai CT, Lin YJ, Hsieh MH, Chen YJ, Lee KT, Tsao HM, Kuo JY, Chang SL, Chen SA. The electrophysiologic characteristics of atrioventricular nodal reentry tachycardia with eccentric retrograde activation. Int J Cardiol 2007; 120:115-22. [PMID: 17161476 DOI: 10.1016/j.ijcard.2006.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 07/11/2006] [Accepted: 09/20/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND The occurrence of eccentric retrograde atrial activation has been demonstrated to be from 6 to 8% in patients with atrioventricular nodal reentrant tachycardia (AVNRT) by several previous reports. However, most of those reports were limited by the absence of coronary sinus venography to confirm if the retrograde activation was truly left sided. The purposes of this study were to 1) determine the incidence of left sided retrograde atrial activation in our center, 2) determine the specific electrophysiologic characteristics of eccentric and concentric atrial activation and 3) determine the outcome of radiofrequency catheter ablation for AVNRT with eccentric retrograde atrial activation. METHODS From November 2001 to July 2004, 290 consecutive patients with AVNRT who underwent an electrophysiologic study and radiofrequency ablation were included. Group 1 consisted of AVNRT patients with eccentric retrograde atrial activation; group 2 consisted of AVNRT patients with concentric retrograde atrial activation. The electrophysiologic characteristics of the group 1 and group 2 patients were then compared. RESULTS The incidence of AVNRT with eccentric retrograde activation confirmed by CS venography was 6.5%. There were more females and atypical AVNRT in patients with retrograde eccentric conduction. There was more VA block after ablation and tachycardia induction by right ventricular pacing/extrastimuli in eccentric rather than concentric retrograde atrial activation. A shorter antegrade fast functional refractory period of the AV node was demonstrated in the atypical eccentric group as compared to the atypical concentric group. CONCLUSION This study demonstrated the different electrophysiologic characteristics between the AVNRT patients with eccentric and concentric retrograde atrial activation. Successful ablation sites were similar to the standard RA ablation sites in patients with retrograde eccentric conduction.
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Affiliation(s)
- Mary Gertrude Y Ong
- Division of Cardiology and Pediatric Cardiology, National Yang-Ming University and Taipei Veterans General Hospital, Taiwan
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46
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Yamabe H, Tanaka Y, Morihisa K, Uemura T, Kawano H, Nagayoshi Y, Kojima S, Ogawa H. Electrophysiologic delineation of the tachycardia circuit in the slow-slow form of atrioventricular nodal reentrant tachycardia. Heart Rhythm 2007; 4:713-21. [PMID: 17556190 DOI: 10.1016/j.hrthm.2007.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 02/09/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the exact boundaries of the reentrant circuit in the slow-slow form of atrioventricular nodal reentrant tachycardia (AVNRT). OBJECTIVE The purpose of this study was to examine the tachycardia circuit in the slow-slow form of AVNRT. METHODS Single extrastimuli were delivered during the slow-slow form of AVNRT at 10 sites along the right interatrial septum: superior portion of the His-bundle (HB) site, the HB site, three equidistantly divided sites of the AV junction between HB site and coronary sinus ostium (CSOS; sites S, M, and I), and inferior, superior, posterior, posteroinferior, and internal portions of the CSOS in 13 patients. The longest coupling interval of a single extrastimulus that reset the tachycardia and the following return cycle were measured. RESULTS The tachycardia cycle length was 409 +/- 50 ms. The earliest atrial electrogram during tachycardia was observed at site I in all patients. The longest coupling intervals at superior-HB, HB site, sites S, M, and I, and inferior-CSOS, superior-CSOS, posterior-CSOS, posteroinferior-CSOS, and internal-CSOS were 340 +/- 52, 355 +/- 50, 367 +/- 50, 378 +/- 51, 398 +/- 49, 398 +/- 52, 355 +/- 60, 351 +/- 50, 371 +/- 48, and 363 +/- 54 ms, respectively. The following return cycles were 468 +/- 52, 453 +/- 52, 442 +/- 52, 431 +/- 50, 411 +/- 52, 410 +/- 49, 454 +/- 45, 457 +/- 57, 438 +/- 54, and 445 +/- 53 ms, respectively. The longest coupling intervals at site I and inferior-CSOS were significantly longer than those at the other sites (P <.0001). The return cycles at site I and inferior-CSOS did not differ from the tachycardia cycle length, whereas those at the other sites were significantly longer than the tachycardia cycle length (P <.0001). CONCLUSION Site I and inferior-CSOS are involved in the slow-slow form of AVNRT circuit, and the atrial tissue between those sites form an integral limb of the reentrant circuit.
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Affiliation(s)
- Hiroshige Yamabe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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47
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Atypical atrioventricular nodal reentrant tachycardia with eccentric coronary sinus activation: Electrophysiological characteristics and essential effects of left-sided ablation inside the coronary sinus. Heart Rhythm 2007; 4:421-32. [DOI: 10.1016/j.hrthm.2006.12.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 12/15/2006] [Indexed: 11/20/2022]
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48
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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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49
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Lee PC, Hwang B, Tai CT, Chiang CE, Chen SA. The Specific Electrophysiologic Characteristics in Children with the Atypical Forms of Atrioventricular Nodal Reentrant Tachycardia. Cardiology 2007; 108:351-7. [PMID: 17308382 DOI: 10.1159/000099108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 10/26/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atrioventricular nodal reentrant tachycardia (AVNRT) is well known to be one of the most common supraventricular tachycardias in childhood. However, information about the atypical forms of AVNRT in childhood is limited. The purpose of this retrospective study was to investigate the clinical and electrophysiologic characteristics in pediatric patients with the atypical forms of AVNRT. METHODS One hundred and three pediatric patients with AVNRT were included (aged 8-18 years; 44 male, 59 female). There were 10 (9.7%) children with the atypical forms (group 1), 86 (83.4%) with the slow-fast form (group 2) and 7 (6.9%) with the fast-slow form of AVNRT (group 3). The electrophysiologic characteristics and results of the radiofrequency catheter ablation were compared among these 3 groups. RESULTS Group 2 patients were associated with an older age when compared with the other two groups. A significantly higher incidence of retrograde dual atrioventricular nodal pathways and a higher percentage of ventricular pacing- and extrastimulation-induced AVNRT were demonstrated in the children with the fast-slow form of AVNRT. The children with the atypical forms of AVNRT had a greater difference in the antegrade 1:1 conduction (100 +/- 73 vs. 52 +/- 41 vs. 35 +/- 26 ms, p = 0.003). Furthermore, the children with the slow-fast form of AVNRT had a greater difference in the retrograde 1:1 conduction (125 +/- 97 vs. 42 +/- 35 vs. 65 +/- 79 ms, p = 0.012). CONCLUSION This study demonstrated that the pediatric patients with the atypical forms of AVNRT had different electrophysiologic characteristics than those with the slow-fast or fast-slow forms of AVNRT. The results of radiofrequency catheter ablation were similar for all children with the slow-fast, fast-slow and atypical forms of AVNRT.
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Affiliation(s)
- Pi-Chang Lee
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
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Richter S. [4. Apropos of postpacing interval]. Herzschrittmacherther Elektrophysiol 2007; 17:239-41. [PMID: 17211758 DOI: 10.1007/s00399-006-0532-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S Richter
- Heart Rhythm Management Institute, Free University of Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.
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