Limitations of ventricular pacing maneuvers to differentiate orthodromic reciprocating tachycardia from atrioventricular nodal reentry tachycardia

Kupó, Péter; Tutuianu, Cristina; Kaninski, Genadi; Gingl, Zoltán; Sághy, László; Pap, Róbert

doi:10.1007/s10840-021-00993-1

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…A SA-VA interval greater than 85 ms was considered indicative of AVNRT. Additionally, the corrected postpacing interval minus the tachycardia cycle length was calculated, and a value greater than 110 ms supported the diagnosis of AVNRT [12,13].…”

Section: Ice-guided Ablation Groupmentioning

confidence: 99%

Electroanatomical Mapping System-Guided vs. Intracardiac Echocardiography-Guided Slow Pathway Ablation: A Randomized, Single-Center Trial

Bocz,

Debreceni,

Janosi

et al. 2023

JCM

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Radiofrequency (RF) catheter ablation is an effective treatment option for targeting the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT). Previous data suggested that using intracardiac echocardiography (ICE) guidance could improve procedural outcomes when compared to using fluoroscopy alone. In this prospective study, we aimed to compare the effectiveness of an electroanatomical mapping system (EAMS)-guided approach with an ICE-guided approach for SP ablation. Eighty patients undergoing SP ablation for AVNRT were randomly assigned to either the ICE-guided or EAMS-guided group. If the procedural endpoint was not achieved after 8 RF applications; patients were allowed to crossover to the ICE-guided group. The ICE-guided approach reduced the total procedure time (61.0 (56.0; 66.8) min vs. 71.5 (61.0; 80.8) min, p < 0.01). However, the total fluoroscopy time was shorter (0 (0–0) s vs. 83.5 (58.5–133.25) s, p < 0.001) and the radiation dose was lower (0 (0–0) mGy vs. 3.3 (2.0–4.7) mGy, p < 0.001) with EAMS-guidance. The ICE-guided group had a lower number of RF applications (4 (3–5) vs. 5 (3.0–7.8), p = 0.03) and total ablation time (98.5 (66.8–186) s vs. 136.5 (100.5–215.8) s, p = 0.02). Nine out of 40 patients (22.5%) in the EAMS-guided group crossed over to the ICE-guided group, and they were successfully treated with similar RF applications in terms of number, time, and energy compared to the ICE-guided group. There were no recurrences during the follow-up period. In conclusion, the utilization of ICE guidance during SP ablation has demonstrated notable reductions in procedural time and RF delivery when compared to procedures guided by EAMS. In challenging cases, an early switch to ICE-guided ablation may be the optimal choice for achieving successful treatment.

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Section: Ice-guided Ablation Groupmentioning

confidence: 99%

Electroanatomical Mapping System-Guided vs. Intracardiac Echocardiography-Guided Slow Pathway Ablation: A Randomized, Single-Center Trial

Bocz,

Debreceni,

Janosi

et al. 2023

JCM

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“…The former, although not specific, is often observed during ventricular overdrive pacing of the superior-type, fast-slow AVNRT, probably because the retrograde conductivity of the lower common pathway decreases as the tachycardia develops, inhibiting the retrograde penetration into the AV nodal reentry circuit [ 12 ]. The latter may never occur with AV reentrant tachycardia using a right septal accessory pathway, due to the repetitive or fully premature retrograde penetration of the accessory pathway in the QRS transition zone during ventricular pacing from the site ipsilateral to the accessory pathway [ 27 ]. This is in contrast with AV reentrant tachycardia using a left lateral accessory pathway, where a false negative response is occasionally observed [ 27 ].…”

Section: Variants Of Sp Extending To the Tricuspid Annulus And Their ...mentioning

confidence: 99%

“…The latter may never occur with AV reentrant tachycardia using a right septal accessory pathway, due to the repetitive or fully premature retrograde penetration of the accessory pathway in the QRS transition zone during ventricular pacing from the site ipsilateral to the accessory pathway [ 27 ]. This is in contrast with AV reentrant tachycardia using a left lateral accessory pathway, where a false negative response is occasionally observed [ 27 ]. Moreover, the atrial preexcitation phenomenon typically diagnostic of AV reentry [ 28 ] and evidenced by atrial resetting of the tachycardia by a single premature ventricular stimulus delivered during His bundle refractoriness, may be absent if the tachycardia uses a slowly conducting accessory pathway, because of the decremental conduction caused by the ventricular stimulus [ 29 ].…”

Section: Variants Of Sp Extending To the Tricuspid Annulus And Their ...mentioning

confidence: 99%

Atrioventricular Ring Tachycardias: Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia and Atrial Tachycardia Share a Common Arrhythmogenic Substrate—A Unifying Proposal

Kaneko¹,

Tamura²,

Kubo³

et al. 2022

Rev. Cardiovasc. Med.

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Our understanding of the variants of slow pathway (SP) and associated atypical atrioventricular (AV) nodal reentrant tachycardia (NRT) is still growing. We have identified variants extending outside Koch's triangle along the tricuspid annulus, including superior, superoanterior and inferolateral right atrial SP and associated atypical, fast-slow AVNRT. We review the history of each variant, their electrophysiological characteristics and related atypical AVNRT, and their treatment by catheter ablation. We focused our efforts on organizing the published information, as well as some unpublished, reliable data, and show the pitfalls of electrophysiological observations, along with keys to the diagnosis of atypical AVNRT. The superior-type of fast-slow AVNRT mimics adenosine-sensitive atrial tachycardia originating near the AV node and can be successfully treated by ablation of a superior SP form the right side of the perihisian region or from the non-coronary sinus of Valsalva. Fast-slow AVNRT using a superoanterior or inferolateral right atrial SP also mimics atrial tachycardia originating from the tricuspid annulus. We summarize the similarities among these variants of SP, and the origin of the atrial tachycardias, including their anatomical distributions and electrophysiological and pharmacological characteristics. Moreover, based on recent basic research reporting the presence of node-like AV ring tissue encircling the annuli in adult hearts, we propose the term "AV ring tachycardia" to designate the tachycardias that share the AV ring tissue as a common arrhythmogenic substrate. This review should help the readers recognize rare types of SP variants and associated AVNRT, and diagnose and cure these complex tachycardias. We hope, with this proposal of a unified tachycardia designation, to open a new chapter in clinical electrophysiology.

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Transcatheter ablation of atrioventricular nodal reentry tachycardia in children and congenital heart disease in the era of 3D mapping

Drago,

Flore,

Raimondo

et al. 2024

Front. Cardiovasc. Med.

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Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia in children and congenital heart disease (CHD) patients. Nowadays, in large enough children, chronic treatment for symptomatic and recurrent AVNRT episodes relies on transcatheter ablation. Indeed, many three-dimensional (3D) mapping strategies and ablation techniques have been developed and it helped to increase success rates and to reduce complications. Therefore, this study aimed to perform an updated comprehensive review of the available literature regarding contemporary management of AVNRT in children. A literature search was performed using Google Scholar, PubMed, Springer, Ovid, and Science Direct. We found that in recent times many investigations have demonstrated that 3D mapping systems allow to localize more precisely the ablation substrate, with minimal use of fluoroscopy. The most frequently employed mapping strategies are the low-voltage bridge strategy together with the search for the SP potential and the Sinus Rhythm Propagation Map with the identification of areas of Wave Collision or Pivot Points. For transcatheter ablation in pediatric settings, radiofrequency (RF) ablation was first used in the 1990s, while cryoablation was introduced in 2003 and nowadays represents the most used energy for AVNRT ablation in this population. Indeed, its specific features, such as reversible cryomapping, cryoadhesion and the precision in lesion delivery, made this technique very appealing to decrease complications and fluoroscopy time. As regards AVNRT in CHD patients, it represents the third most common form of arrhythmia in children with CHD. However, in this subgroup ablation remains challenging and experience limited, since anatomy may be atypical and the areas of ablation less predictable or less accessible.

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Limitations of ventricular pacing maneuvers to differentiate orthodromic reciprocating tachycardia from atrioventricular nodal reentry tachycardia

Cited by 3 publications

References 26 publications

Electroanatomical Mapping System-Guided vs. Intracardiac Echocardiography-Guided Slow Pathway Ablation: A Randomized, Single-Center Trial

Electroanatomical Mapping System-Guided vs. Intracardiac Echocardiography-Guided Slow Pathway Ablation: A Randomized, Single-Center Trial

Atrioventricular Ring Tachycardias: Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia and Atrial Tachycardia Share a Common Arrhythmogenic Substrate—A Unifying Proposal

Transcatheter ablation of atrioventricular nodal reentry tachycardia in children and congenital heart disease in the era of 3D mapping

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