Coexistence of Atrioventricular Nodal Reentrant Tachycardia with Other Forms of Arrhythmias

Abstract

Objective: The aim of this retrospective study was to investigate the association of atrioventricular nodal reentrant tachycardia (AVNRT) with other forms of arrhythmia in individual patients and its consequences for treatment. Subjects and Methods: This study comprised 493 consecutive patients aged 16-88 years (296 women and 197 men) who were diagnosed with a form of AVNRT via a standard 4-catheter electrophysiological study (EPS). Patients were clinically followed (range 0.5-12 years) at a single center. Results: Coexistence of AVNRT with other types of tachycardias was observed in 197 (40%) patients. Atrial fibrillation was found most frequently in 94 (19%) patients as follows: focal atrial tachycardia, n = 40 (8%); atrial flutter, n = 32 (6%), and AV reentrant tachycardia, n = 22 (4%). Double tachycardia was present in 140 (30%) patients, and more than 2 different types of tachycardias were present in 57 (12%) patients. Transitions between AVNRT and other tachycardias occurred in 25 (5%) patients. Two or more tachycardias were ablated in 42 (9%) patients. The majority of patients were free of symptoms at the first follow-up, whereas 130 (26%) patients reported a variety of symptoms. Conclusion: Coexistence of AVNRT with other types of arrhythmias was a common finding among these patients. The most frequently observed double tachycardia was the combination of AVNRT with atrial tachyarrhythmias, such as atrial fibrillation, with a potential significance for further patient management.

Interesting electrophysiological findings in a patient with coexistence of atrial tachycardia originating from coronary sinus and slow-fast atrioventricular nodal reentrant tachycardia

“…demonstrated that AT was induced in 15% of patients who underwent slow pathway ablation [4]. The most common cause of concomitant arrhythmia with slow-fast AVNRT was reported to be atrial fibrillation, followed by AT which accounted for 8% of all cases [5]. However, the exact mechanism of the coexistence of AVNRT with AT, especially the AT originating from Koch triangle, remains indeterminable although there is estimated to be an interaction between AV nodal tissue and perinodal tissue [6].…”

“…We performed RFA with imaginable two possibilities of the tachycardia: slow-fast AVNRT and adenosine-sensitive AT. Adenosine-sensitive AT, which was characterized by the feature of high sensitivity to ATP, was inconsistent with the incidence of (4) and (5). We finally performed slow pathway ablation initially in the posterior atrial septum, followed by inside CS, and in the middle atrial septum targeting temperature of 558 and a power of 30 W, which finally achieved the slow pathway ablation.…”

Long-term outcomes after catheter-ablation of atrioventricular nodal reentrant tachycardia: A ten-year follow-up

“…The assumption for the onset of atrial flutter is that the slow pathway is anatomically close to zone of slow conduction in the right atrium 12,13 . In the study of Schernthaner et al 14 , 35% of patients in the follow-up period had arrhythmias that required the use of anti-arrhythmic drugs. It is possible that AVNRT is a substrate for the occurrence of atrial fibrillation in a group of younger patients 15 , and in these patients, slow pathway ablation would be sufficient to prevent atrial fibrillation.…”

Interesting changeover from short VA to long VA tachycardia with single atrial premature depolarisation: What is the mechanism?

“…There are reported associations of AVNRT with other tachycardia substrates. In a retrospective study, Schernthaner et al reported focal AT in 8% patients in a cohort of 493 patients after ablation for AVNRT [1]. An earlier study had reported 15% subjects had inducible AT recorded during AVNRT ablation.…”