The HAV pattern in pediatric patients with atrioventricular node reentrant tachycardia

Objectives

The purpose of this study is to assess the prevalence of a His-Atrial-Ventricular (HAV) pattern, i.e. the atrial electrogram following the His bundle -HB- electrogram and preceding the ventricular one, on the catheter placed in the His position in pediatric patients during typical atrioventricular node reentry (AVNRT).

Materials and methods

The pediatric electrophysiology databases of two separate institutions were queried for patients with a diagnosis of AVNRT. Demographic, clinical data and the electrophysiology study (EPS) information were assessed.

Results

Thirty-nine consecutive patients were included. Twenty-five were female. The average age at the time of the EPS was 12 ± 3.7 years. Induction was achieved with atrial pacing in 23, with a single atrial extra stimulus in 8 and with dual atrial extra stimuli in 8. Isoproterenol was needed to induce tachycardia in 21. Tachycardia cycle length averaged 320 ± 50 ms. An HAV pattern was present in 35 (74%) of the patients, and in 100% of the patients younger than 8.

Conclusions

An HAV pattern on the catheter placed in the His position, is common in pediatric patients with AVNRT, occurring in up to 74% of the patients in this population, being more common in younger patients.

Electrocardiographic and Electrophysiologic Insights into Atrioventricular Nodal Re-entry Tachycardia: Diagnostic Update

Atrioventricular nodal re-entry tachycardia is a common supraventricular arrhythmia. The rate of recurrence is relatively high, and accordingly ablative therapy became the first-line suggested therapy. In this review, we highlight the electrocardiographic clues to the diagnosis of atrioventricular nodal re-entry tachycardia, also we present the electrophysiological data and maneuvers that enable the ruling out of other supraventricular tachycardias and ensure an accurate and specific diagnosis of atrioventricular nodal reentrant tachycardia.