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Kaneko Y, Naito S, Okishige K, Morishima I, Tobiume T, Nakajima T, Irie T, Ota M, Iijima T, Iizuka T, Tamura M, Tamura S, Saito A, Igawa O, Kato R, Matsumoto K, Suzuki F, Kurabayashi M. Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Incorporating a "Superior" Slow Pathway: A Distinct Supraventricular Tachyarrhythmia. Circulation 2015; 133:114-23. [PMID: 26541829 DOI: 10.1161/circulationaha.115.018443] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The existence of an atypical fast-slow (F/S) atrioventricular nodal reentrant tachycardia (AVNRT) including a superior (sup) pathway with slow conductive properties and an atrial exit near the His bundle has not been confirmed. METHODS AND RESULTS We studied 6 women and 2 men (age, 74 ± 7 years) with sup-F/S-AVNRT who underwent successful radiofrequency ablation near the His bundle. Programmed ventricular stimulation induced retrograde conduction over a superior SP with an earliest atrial activation near the His bundle, a mean shortest spike-atrial interval of 378 ± 119 milliseconds, and decremental properties in all patients. sup-F/S-AVNRT was characterized by a long-RP interval; a retrograde atrial activation sequence during tachycardia identical to that over a sup-SP during ventricular pacing; ventriculoatrial dissociation during ventricular overdrive pacing of the tachycardia in 5 patients or atrioventricular block occurring during tachycardia in 3 patients, excluding atrioventricular reentrant tachycardia; termination of the tachycardia by ATP; and a V-A-V activation sequence immediately after ventricular induction or entrainment of the tachycardia, including dual atrial responses in 2 patients. Elimination or modification of retrograde conduction over the sup-SP by ablation near the right perinodal region or from the noncoronary cusp of Valsalva eliminated and confirmed the diagnosis of AVNRT in 4 patients each. CONCLUSIONS sup-F/S-AVNRT is a distinct supraventricular tachycardia, incorporating an SP located above the Koch triangle as the retrograde limb, that can be eliminated by radiofrequency ablation.
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Affiliation(s)
- Yoshiaki Kaneko
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.).
| | - Shigeto Naito
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Kaoru Okishige
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Itsuro Morishima
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Takeshi Tobiume
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Tadashi Nakajima
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Tadanobu Irie
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Masaki Ota
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Takafumi Iijima
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Takashi Iizuka
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Mio Tamura
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Shuntaro Tamura
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Akihiro Saito
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Osamu Igawa
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Ritsushi Kato
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Kazuo Matsumoto
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Fumio Suzuki
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Masahiko Kurabayashi
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
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