Irregular Atrial Activation During Atrioventricular Nodal Reentrant Tachycardia:

Abstract

Controversy continues regarding the precise nature of the reentrant circuit of AV nodal reentrant tachycardia, especially the existence of an upper common pathway. In this case report, we show that marked variation and irregularity in atrial activation (maximum AA interval variation of 80 msec) can exist with fixed and constant activation of the His bundle and ventricles during AV nodal reentrant tachycardia in a 45‐year‐old female patient. We propose that irregular atrial activation is due to variable and inconsistent conduction from the AV node to the atria through the perinodal transitional cell envelope extrinsic to the reentrant circuit. Our observations support the concept of an upper common pathway, at least in some patients with AV nodal reentrant tachycardia. (J Cardiovasc Electrophysiol, Vol. 14, pp. 309‐313, March 2003)

Persistent VA dissociation during atrioventricular nodal reentry tachycardia: The existence of upper common pathway

“…We report a patient with AVNRT continuing despite the occurrence of VA dissociation, which suggests that an upper common pathway may exist. This was perceived as a link between the fast and slow pathways consisting of transitional cells and conducting to the atria through the transitional envelope . To the best of our knowledge, this case is the first report of AVNRT with persistent VA dissociation.…”

Ventriculatrial Block During Atrioventricular Nodal Reentrant Tachycardia Suggesting Existence of an Upper Common Pathway

“…Guo, et al in their case report demonstrated irregular atrial activation during AVNRT while HH and VV intervals remained constant and suggested that conduction variation through the perinodal transitional cell envelope and intra-atrium, which are out of the AV nodal reentrant circuit, could be responsible for that irregular atrial activation pattern. 4) Chen, et al reported atrial fibrillation developing in both atria during continuing AVNRT, which is also evidence that the atrium is not necessary in AVNRT. 5) VA block during AVNRT was first described by Wellens, et al in one of their 67 cases with AVNRT.…”

“…2) Since then, some studies have demonstrated that AV nodal reentry is confined to the AV node [4][5][6][7][8][9][10][11][12][13] while others support the concept that the atrial myocardium is essential for AV node reentry to occur. [14][15][16][17] We report a patient with AVNRT continuing despite the occurrence of VA block, which suggests that an upper common pathway exists and that the atrial myocardium is not part of the reentrant circuit.…”

Wide QRS Tachycardia with Ventriculoatrial Dissociation in Early Postoperative Aortic Valve Replacement Period: An Atypical Nodal Reentry Presentation

“…In the EPS, the onset of irregularity in the AA activity, even with a true Wenckebach phenomenon, would express a conduction delay between the AV nodal and low atrium cells, as described by Guo et al [4]; in our case, this would be explained by the inflammation of perinodal tissue following surgery.…”