Heterogeneity of anterograde fast-pathway and retrograde slow-pathway conduction patterns in patients with the fast–slow form of atrioventricular nodal reentrant tachycardia: electrophysiologic and electrocardiographic considerations

Nawata, Hiroko; Yamamoto, Nobuto; Hirao, Kazuyuki; Miyasaka, Nobuyuki; Kawara, Tokuhiro; Hiejima, Kazumasa; Harada, Tomoo; Suzuki, Fumio

doi:10.1016/s0735-1097(98)00433-1

Cited by 51 publications

(39 citation statements)

References 27 publications

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“…These findings suggest the presence of a discrete anatomic structure for the slow pathway, as suggested by Inoue et al 25 Recently, heterogeneity of the fast and slow pathway conduction patterns in the FS-AVNRT was reported. 20 Similarly, multiple forms and variant forms of AVNRT have been reported. 10,11,18 Wu et al 10 proposed that a double loop figure-8 reentry was the mechanism of multiple forms of AVNRT.…”

Section: Tachycardia Circuit In the Fs-avnrtmentioning

confidence: 93%

“…Nawata et al 20 also reported that the FS-AVNRT was reset by atrial single extrastimuli. In the present study, the extrastimulus delivered during late diastole began to reset the FS-AVNRT, and the subsequent return cycles were almost uniformly identical to the tachycardia cycle length at 4 atrial sites (sites HB, S, M, and I).…”

Section: Atrial Myocardium Participated In the Reentry Circuitmentioning

confidence: 96%

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Demonstration of the Exact Anatomic Tachycardia Circuit in the Fast-Slow Form of Atrioventricular Nodal Reentrant Tachycardia

Yamabe

Shimasaki²,

Honda³

et al. 2001

Circulation

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Background-The tachycardia circuit in the fast-slow form of atrioventricular nodal reentrant tachycardia (FS- AVNRT) has not been convincingly defined. Methods and Results-To define the tachycardia circuit, single extrastimuli were delivered during FS-AVNRT to 9 intra-atrial sites in 12 patients: the His bundle (HB) site; the superior portion of the HB site (S-HB); 3 arbitrarily divided sites on the AV junction extending from the HB site to the coronary sinus ostium (CSOS) (sites S, M, and I); the superior, posterior, and posteroinferior portions of the CSOS (S-CSOS, P-CSOS, and PI-CSOS, respectively); and the CSOS. The inferior portion of coronary sinus ostium (I-CSOS), at which the earliest retrograde activation was observed, was excluded. At each site, the longest coupling interval of the single extrastimulus that reset the tachycardia and the subsequent return cycle was measured. The mean tachycardia cycle length was 370Ϯ55 ms. The longest coupling intervals at sites S-HB, HB, S, M, I, CSOS, S-CSOS, P-CSOS, and PI-CSOS were 328Ϯ53, 360Ϯ55, 358Ϯ55, 358Ϯ54, 360Ϯ55, 338Ϯ56, 323Ϯ54, 331Ϯ56, and 321Ϯ58 ms, respectively, and the subsequent return cycles were 408Ϯ58, 371Ϯ55, 370Ϯ55, 372Ϯ56, 370Ϯ55, 396Ϯ56, 411Ϯ60, 405Ϯ58, and 412Ϯ59 ms, respectively. The longest coupling intervals at sites HB, S, M, and I were longer than those at S-HB, CSOS, S-CSOS, P-CSOS, and PI-CSOS (PϽ0.0001).The return cycles at sites HB, S, M, and I did not differ from the tachycardia cycle length, whereas those at CSOS, S-CSOS, P-CSOS, and PI-CSOS were longer than the tachycardia cycle length (PϽ0.0001). Conclusions-The perinodal atrium extending from the HB site to the I-CSOS is an integral limb of the reentry circuit in

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Section: Tachycardia Circuit In the Fs-avnrtmentioning

confidence: 93%

Section: Atrial Myocardium Participated In the Reentry Circuitmentioning

confidence: 96%

Demonstration of the Exact Anatomic Tachycardia Circuit in the Fast-Slow Form of Atrioventricular Nodal Reentrant Tachycardia

Yamabe

Shimasaki²,

Honda³

et al. 2001

Circulation

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“…Anatomically, the slow pathway corresponds to a discrete right posterior extension of the compact AV node running along the inferior and posterior tricuspid annulus, 10) though rare cases of AVNRT have been reported where atrial activation mapping during tachycardia, 11,12) successful ablation outcome, 13) or intraoperative ice mapping 14) suggested that it was anterior to the fast pathway. However, we found no report of AVNRT where the reentrant circuit included a slow pathway exiting to a noncoronary sinus of Valsalva.…”

Section: Discussionmentioning

confidence: 99%

Successful Ablation of Atypical Atrioventricular Nodal Reentrant Tachycardia From a Noncoronary Sinus of Valsalva

et al. 2014

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SummaryAn 81-year-old man with long RP narrow QRS tachycardia underwent catheter ablation. Ventricular pacing reset the atrial cycle over a retrograde slow pathway, followed by termination of the tachycardia without atrial capture, confi rming the diagnosis of fast-slow atrioventricular nodal reentrant tachycardia (AVNRT). The earliest atrial activation during tachycardia was found in the noncoronary sinus of Valsalva, where the fi rst delivery of radiofrequency energy terminated and eliminated the inducibility of the tachycardia, by retrograde conduction block over the slow pathway. This is the fi rst report of a fast-slow AVNRT, with successful ablation of the slow pathway from a noncoronary sinus of Valsalva. (Int Heart J 2014; 55: 84-86) Key words: Supraventricular tachycardia, Atrioventricular nodal tachycardia, Slow pathway ablation, Noncoronary cusp S low pathway ablation is a curative treatment for atrioventricular (AV) nodal reentrant tachycardia (NRT), and is usually performed with lesions created in the inferior or mid segment of the triangle of Koch.1-3) We describe a rare, atypical AVNRT successfully treated by ablation of a slow pathway from a noncoronary aortic cusp. Case ReportAn 81-year-old man who had a history of multiple episodes of paroxysmal supraventricular tachycardia underwent electrophysiologic studies and a catheter ablation procedure. A 12-lead electrocardiogram during tachycardia showed a long RP tachycardia with biphasic P waves in leads II, III, and aVF. Atrial extrastimulation elicited no dual anterograde AV nodal conduction. Decremental ventriculoatrial conduction and maximum 1:1 conduction at a rate of 110 ppm were observed, with the earliest atrial activation site in the bundle of His region, consistent with retrograde AV nodal conduction (Figure 1). A narrow QRS tachycardia documented previously was reproducibly induced by atrial extrastimulation at a coupling interval of 400 ms to 290 ms and ventricular overdrive pacing (Figure 1). During tachycardia with stable 1:1 AV conduction, the earliest atrial activation was recorded at the bundle of His, as was observed during ventricular overdrive pacing. Retrograde VA conduction could not be evaluated by ventricular extrastimulus due to incessant tachycardia easily induced by ventricular basic stimulation. Wenckebach periodicity with a similar atrial activation sequence was also frequently observed during ongoing tachycardia, excluding the diagnosis of AV reentrant tachycardia. A 4-mg bolus injection of adenosine triphosphate (ATP) reproducibly terminated the tachycardia after a last ventricular event, following incremental prolongation of the atrial cycle length. Ventricular extrastimuli delivered during the tachycardia did not reset the atrial cycle, though ventricular overdrive pacing at a cycle length slightly shorter than that of the tachycardia reset the atrial cycles and terminated the tachycardia (Figure 2). Presuming the presence of dual AV nodal conduction, the electrophysiological observations shown in Figure 2 are exp...

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“…Earliest atrial activation can be well recorded at the coronary sinus ostium, the low right atrial septum, or the His bundle area. [11][12][13]17 In certain cases of atypical AVNRT, retrograde atrial activation is even suggestive of a left lateral accessory pathway. 8,9 It is obvious, therefore, that classification based on earliest atrial retrograde activation is inappropriate.…”

Section: Earliest Atrial Retrograde Activationmentioning

confidence: 99%

“…In order to establish the diagnosis of a truly fast-slow form, it has been proposed that the AH interval should be less than 185 ms 10 or 200 ms. 6 This criterion, however, has not been adopted by other investigators. [11][12][13] Thus, tachycardias with a relatively prolonged AH interval but an AH/ HA ratio <1 cannot be reliably classified as either fast-slow or slow-slow (see Figure 2). Furthermore, the term 'fast-slow' implies that the fast component of slow-fast AVNRT is the same as the fast in the fast-slow type.…”

mentioning

confidence: 99%

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

Katritsis

Josephson

2016

Arrhythmia &Amp; Electrophysiology Review

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Atrioventricular nodal reentrant tachycardia (AVNRT) denotes re-entry in the area of the AV node, and represents the most common regular arrhythmia in the human.1 Although several models have been proposed to explain the mechanism of the arrhythmia in the context of the complex anatomy and the anisotropic properties of the atrioventricular (AV) node and its atrial extensions (see Figure 1), 2 the actual circuit of AVNRT still remains elusive. Recent studies suggest a three-dimensional AV node with greater variability in the space constant of tissue and poor gap junction connectivity due to differential expression of connexin isoforms, that provide an explanation of dual conduction and nodal reentrant arrhythmogenesis. 3,4 AV junctional arrhythmias are presented in Table 1. Classification schemes for AVNRT have been mainly based on the conventional concept of longitudinally dissociated dual AV nodal pathways that conduct around a central obstacle (see Table 2).In typical slow-fast AVNRT the onset of atrial activation appears prior to, at the onset, or just after the QRS complex, thus maintaining an atrial-His/His-atrial ratio, AH/HA >1. The HA interval is usually <70 ms, measured from earliest deflection of the His bundle activation to the earliest rapid deflection of the atrial activation in the His bundle electrogram, and the VA interval, measured from the onset of ventricular activation on surface ECG to the earliest rapid deflection of the atrial activation on the His bundle electrogram, is <60 ms. 1,5,6 In atypical, fast-slow form of atypical AVNRT, the retrograde atrial electrogram begins after ventricular activation with an AH/HA ratio <1. The HA interval is prolonged, ≥70 msec, and the VA interval is ≥60 msec. 5,6 The atypical, slow-slow form, represents, by definition, an arrhythmia utilising two slow pathways. The AH/HA ratio is ≥1 but the HA interval is ≥70 msec, and the AH interval exceeds 200 ms. [7][8][9] There are several inherent limitations of this classification. The distinction between fast-slow and slow-slow atypical AVNRT is often arbitrary in view of the lack of a unanimously accepted definition. In order to establish the diagnosis of a truly fast-slow form, it has been proposed that the AH interval should be less than 185 ms 10 or 200 ms. 6 This criterion, however, has not been adopted by other investigators. 11-13Thus, tachycardias with a relatively prolonged AH interval but an AH/ HA ratio <1 cannot be reliably classified as either fast-slow or slow-slow (see Figure 2). Furthermore, the term 'fast-slow' implies that the fast component of slow-fast AVNRT is the same as the fast in the fast-slow type. There is now evidence that this is not the case in patients who present with both types of tachycardia.14,15 Typical slow-fast and atypical fast-slow AVNRT appear to utilise different anatomical pathways for fast conduction. In addition, electrophysiological behaviour compatible with multiple pathways may also be seen, and in some patients, several forms of AVNRT may be inducible at electrophy...

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Heterogeneity of anterograde fast-pathway and retrograde slow-pathway conduction patterns in patients with the fast–slow form of atrioventricular nodal reentrant tachycardia: electrophysiologic and electrocardiographic considerations

Cited by 51 publications

References 27 publications

Demonstration of the Exact Anatomic Tachycardia Circuit in the Fast-Slow Form of Atrioventricular Nodal Reentrant Tachycardia

Demonstration of the Exact Anatomic Tachycardia Circuit in the Fast-Slow Form of Atrioventricular Nodal Reentrant Tachycardia

Successful Ablation of Atypical Atrioventricular Nodal Reentrant Tachycardia From a Noncoronary Sinus of Valsalva

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

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